【摘要】 目的 研究确诊为类风湿关节炎相关性间质性肺疾病（rheumatoid arthritis-associated interstitial lung disease,RA-ILD）患者1年内发生进展性肺纤维化（progressive pulmonary fibrosis,PPF）的危险因素并开发列线图。方法 回顾性研究2010年1月—2022年10月期间于青岛大学附属医院诊断并随访的145例RA-ILD患者。其中，106例和39例患者分别被随机分配到训练组和验证组。通过单因素与多因素Logistic回归分析确定RA-ILD患者1年内发生PPF的独立预测因子。然后通过这些独立的预测变量建立列线图。采用校准曲线、Hosmer-Lemeshow检验、受试者操作特征（receiver operating characteristic,ROC）曲线和曲线下面积（area under ROC curve,AUC）以及临床决策曲线评估列线图模型对RA-ILD患者1年内出现PPF的预测效能，并使用内部验证来测试模型的稳定性。结果 145例RA-ILD患者中，62例（42.76%）的患者1年内发生PPF，其中训练组40例（37.7%），验证组22例（56.41%）。PPF组患者中存在胸膜下异常的比例较高，纤维化视觉评分较高，类风湿关节炎持续时间较短。Logistic回归分析结果显示，类风湿关节炎持续时间、纤维化视觉评分和胸膜下异常是预测RA-ILD患者确诊后1年内发生PPF的独立危险因素。基于这些独立危险因素构建列线图模型，训练组和验证组列线图的AUC值分别为0.798[95%置信区间（confidence interval,CI）0.713～0.882]和0.822(95%CI 0.678～0.967)，表明模型具有较好的区分能力。临床决策曲线表明，当风险阈值为0.06～0.71时，PPF风险预测模型的临床获益更大。结论 根据类风湿关节炎持续时间、纤维化视觉评分和胸膜下异常的存在绘制PPF的预测模型，可为RA-ILD患者确诊后1年内发生PPF的临床预测提供参考。更多还原

【Abstract】 Objective To study the risk factors of developing progressive pulmonary fibrosis(PPF) within one year in patients diagnosed with rheumatoid arthritis-associated interstitial lung disease(RA-ILD), and develop a nomogram. Methods A retrospective study was conducted in 145 cases of RA-ILD patients diagnosed and followed up in the Affiliated Hospital of Qingdao University from January 2010 to October 2022. Among them, 106 patients and 39patients were randomly assigned to a training group and a verification group. The independent predictors of PPF in patients with RA-ILD within one year were determined by univariate and multivariate logistic regression analysis. Then a nomogram is established through these independent predictive variables. Calibration curve, Hosmer-Lemeshow test,receiver operating characteristic(ROC) curve and area under ROC curve(AUC) and clinical decision curve were used to evaluate the predictive efficiency of the nomogram model for PPF in RA-ILD patients within one year. Finally, internal validation was used to test the stability of the model. Results Of the 145 patients with RA-ILD, 62(42.76%) developed PPF within one year, including 40(37.7%) in the training group and 22(56.41%) in the verification group. The PPF patients had higher proportion of subpleural abnormalities, higher visual score of fibrosis and shorter duration of RA. Logistic regression analysis showed that the duration of rheumatoid arthritis(RA), visual score of fibrosis and subpleural abnormality were independent risk factors for the occurrence of PPF within one year after diagnosis of RA-ILD. A nomogram was constructed based on these independent risk factors. The AUC values of the training group and the verification group were 0.798(95%CI 0.713-0.882) and 0.822(95%CI 0.678-0.967) respectively, indicating that the model had a good ability to distinguish. The clinical decision curve showed that the clinical benefit of PPF risk prediction model was greater when the risk threshold was between 0.06 and 0.71. Conclusion According to the duration of RA, the visual score of fibrosis and the presence of subpleural abnormalities, the predictive model of PPF was drawn to provide reference for the clinical prediction of PPF in patients with RA-ILD within one year after diagnosis.更多还原