【摘要】 目的 基于外周血多项实验室指标探讨中医湿证发生的危险因素，构建预测模型并验证。方法 回顾性分析2022年5月～2023年12月在广东省中医院治未病中心就诊的180例患者，根据诊断标准分为中医湿证组（n=118）与平和质组（n=62），平和质为中医湿证的“无证”对照组。采用电化学发光法(ECL)检测血清生化指标，流式细胞仪(FCM)检测免疫细胞亚群比例，全自动血液分析仪检测血细胞指标。采用Logistic回归分析筛选危险因素并构建预测模型。采用Bootstrap法对数据进行重抽样，绘制受试者工作特征（ROC）曲线、校准曲线、临床决策曲线（DCA）评价模型的预测价值、一致性和临床效能。结果 与平和质组比较，中医湿证组的胰岛素（INS）、非高密度脂蛋白胆固醇(non HDL-C)、红细胞计数（RBC）和CD4~+T细胞比例水平升高，甘油三酯（TG）> 1.70 mmol/L，总胆固醇（TC）> 5.20 mmol/L，低密度脂蛋白-胆固醇（LDL-C）>3.37 mmol/L，高密度脂蛋白胆固醇（HDL-C）≤1.15 mmol/L比例增加，差异具有统计学意义（U/t/χ~2=-2.900～4 626，均P<0.05）。Logistic回归分析显示，INS,TC > 5.20 mmol/L,HDL-C≤1.15 mmol/L,CD4~+T细胞比例均为中医湿证发生的独立危险因素（均P<0.05）。根据筛选出的危险因素构建预测模型，绘制列线图。该模型预测中医湿证的受试者工作特征（ROC）曲线下面积（AUC）为0.747(95%CI=0.672～0.822)，预测模型的校准曲线Brier评分为0.184，预测模型在阈值概率为0.30～1.00时具有临床净获益。结论 基于INS,TC>5.20 mmol/L,HDL-C≤1.15 mmol/L,CD4~+T细胞比例构建的预测模型对中医湿证有较高的预测价值。更多还原

【Abstract】 Objective To explore the risk factors associated with the occurrence of dampness syndrome based on peripheral blood multiple laboratory indicators, construct predictive model and validate it. Methods A retrospective analysis was conducted on 180 patients who visited the Preventive Treatment Center of Guangdong Provincial Hospital of Chinese Medicine from May 2022 to December 2023. They were divided into two groups according to the diagnostic criteria: the damp syndrome of TCM group(n=118) and the balanced yin-yang constitution group(n=62), with the latter serving as the “non-syndrome” control group for dampness syndrome. Serum biochemical indicators were detected by electrochemiluminescence(ECL), immune cell subsets were analyzed through flow cytometer, and routine blood parameters were assessed using an automatic hematology analyzed. Logistic regression analysis was employed to screen risk factors and develop a predictive model. The Bootstrap method was used for data resampling to draw the receiver operating characteristic(ROC) curve, calibration curve, and clinical decision curve analysis(DCA) to evaluate the predictive value, consistency, and clinical efficacy of the model. Results Compared with the balanced yin-yang constitution group, the damp syndrome of TCM group showed increased levels of insulin(INS), non-high-density lipoprotein cholesterol(non HDL-C), red blood cells(RBC) and the proportion of CD4~+T cells, the proportion of triglyceride(TG) >1.70 mmol/L, total cholesterol(TC) >5.20 mmol/L, low-density lipoprotein cholesterol(LDL-C) >3.37 mmol/L, and high-density lipoprotein cholesterol(HDL-C) ≤ 1.15 mmol/L were also significantly higher, with statistical significance(U/t/χ~2=-2.900～4 626, all P < 0.05). Logistic regression analysis showed that INS, TC>5.20 mmol/L, HDL-C ≤ 1.15 mmol/L, and the proportion of CD4~+T cells were independent risk factors for the occurrence of damp syndrome of TCM(all P < 0.05). Based on the screened risk factors, a forecasting model was established and a nomogram was plotted. The model had an area under the ROC curve area under curve(AUC) of 0.747(95% CI=0.672～0.822), a Brier score of 0.184 for the calibration curve, and demonstrated clinical net benefit at threshold probabilities ranging from 0.30 to 1.00. Conclusion The forecasting model constructed based on INS, TC>5.20 mmol/L, HDL-C ≤ 1.15 mmol/L, and CD4~+T cells ratio has a high predictive value for damp syndrome of TCM.更多还原