Study on risk factors and prediction model of skin necrotic infection caused by venomous snake bites
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摘要: 目的 分析毒蛇咬伤致皮肤坏死性感染的危险因素，并构建预测模型。方法 回顾性分析99例毒蛇咬伤患者的临床资料，确定是否发生皮肤坏死性感染为结局，采用单因素及多因素logistics回归分析构建预测模型并予以验证。结果 蛇伤严重度评分、血糖及D-二聚体水平为毒蛇咬伤致皮肤坏死性感染的危险因素(均P < 0.05)。利用上述危险因素构建列线图预测模型，预测发生皮肤坏死性感染的曲线下面积分别为0.92；预测模型的校准曲线在两组中均表现出较好的一致性。结论 蛇伤严重度评分、血糖及D-二聚体水平是毒蛇咬伤后发生皮肤坏死性感染的危险因素，该模型可为临床决策提供参考。Abstract: Objective To analyze the risk factors of skin necrotizing infections caused by venomous snake bites and construct a prediction model.Methods Clinical data of 99 venomous snake bite patients were retrospectively analyzed to determine whether skin necrotizing infection occurred as an outcome, and predictive model was constructed and validated using unifactorial and multifactorial logistic regression analysis.Results Snakebite severity score, blood glucose and D-dimer level were the risk factors of skin necrotizing infections caused by venomous snake bites(all P < 0.05). The area under the curve for predicting the occurrence of skin necrotizing infections was 0.92 using the above risk factors to construct a column-line graph prediction model; the calibration curves of the prediction model showed good consistency in both groups.Conclusion Snakebite severity score, blood glucose and D-dimer levels are risk factors for the occurrence of skin necrotizing infection after venomous snake bites, and the model can provide a reference for clinical decision-making.
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Key words:
- venomous snake bite /
- necrotizing infection /
- risk factor /
- prediction model
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表 1 发生皮肤坏死性感染与未发生皮肤坏死性感染患者一般资料比较
M(Q1，Q3) 一般资料 未发生组(79例) 发生组(20例) P 性别/例(%) 0.928 男 48(60.76) 13(65.00) 女 31(39.24) 7(35.00) 年龄/岁 54.00(41.00，64.50) 54.00(49.00，61.75) 0.903 就诊时间/d 24.00(11.50，29.50) 22.50(8.00，26.00) 0.313 SSS评分/分 3.00(2.00，4.00) 6.00(5.00，6.00) < 0.001 收缩压/mmHga) 125.00(118.00，138.50) 129.50(124.75，145.00) 0.166 舒张压/mmHg 75.00(68.00，84.50) 76.50(69.25，84.00) 0.790 WBC/(×109/L) 11.29(8.79，14.86) 15.80(10.85，18.34) 0.018 PLT/(×109/L) 185.00(86.50，248.00) 145.00(36.75，241.50) 0.280 CRP/(mg/L) 5.60(2.40，11.75) 6.55(1.00，17.18) 0.850 肌酐/(μmol/L) 66.50(57.70，78.35) 83.00(61.88，122.50) 0.037 CK/(U/L) 155.50(95.00，586.75) 135.00(67.25，503.75) 0.427 CK-MB/(U/L) 18.50(14.80，31.35) 22.35(17.38，61.92) 0.109 白蛋白/(g/L) 41.60(38.70，43.30) 41.50(38.90，43.90) 0.910 血糖/(mmol/L) 7.28(6.09，8.89) 8.28(7.22，10.08) 0.025 PT/s 12.20(11.50，13.10) 12.15(11.40，12.98) 0.780 APTT/s 28.30(26.25，30.90) 26.55(24.75，28.27) 0.012 FIB/(g/L) 2.78(2.14，3.33) 1.10(0.36，2.68) 0.013 D-二聚体/(mg/L) 0.36(0.18，0.66) 1.38(0.44，3.74) 0.002 凝血酶时间/s 15.10(13.90，16.55) 15.60(13.93，22.97) 0.322 凝血酶原活动度 86.00(79.00，94.00) 80.50(53.00，88.25) 0.034 注：a)1 mmHg=0.133 kPa。 
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表 2 毒蛇咬伤发生皮肤坏死性感染患者单因素分析
X±S 临床病例特征 未感染组(66例) 感染组(20例) OR P 性别/例(%) 0.78(0.27~2.20) 0.636 男 39(59.1) 13(65.0) 女 27(40.9) 7(35.0) 年龄/岁 52.6±15.2 52.0±15.0 1.00(0.96~1.03) 0.880 就诊时间/d 27.1±19.5 29.2±45.8 1.00(0.99~1.02) 0.761 SSS评分/分 3.3±1.6 5.8±1.7 2.15(1.46~3.15) < 0.001 收缩压/mmHg 125.8±19.7 132.8±16.3 1.03(0.99~1.06) 0.133 舒张压/mmHg 76.0±11.4 77.8±12.0 1.01(0.97~1.06) 0.549 WBC/(×109/L) 13.5±11.9 15.0± 5.5 1.01(0.97~1.06) 0.582 PLT/(×109/L) 182.0±65.0 149.1±41.5 1.00(0.99~1.00) 0.228 CRP/(mg/L) 8.6±3.7 10.6±4.2 1.01(0.97~1.06) 0.504 肌酐/(μmol/L) 69.1±16.1 89.7±37.2 1.03(1.01~1.06) 0.003 CK/(U/L) 1 018.2±452.3 3 993.8±1 242.0 1.00(1.00~1.00) 0.257 CK-MB/(U/L) 55.5±32.2 112.3±41.2 1.00(1.00~1.00) 0.299 白蛋白/(g/L) 41.3±3.9 40.7±6.1 0.97(0.87~1.08) 0.575 血糖/(mmol/L) 7.6±2.3 9.4±4.3 1.20(1.00~1.43) 0.044 PT/s 12.5±1.4 11.1±5.2 0.86(0.72~1.02) 0.081 APTT/s 28.8±3.1 23.2±10.3 0.83(0.70~0.98) 0.029 FIB/(g/L) 2.5±1.1 1.6±1.4 0.56(0.36~0.85) 0.007 D-二聚体/(mg/L) 0.7±0.2 3.9±1.0 1.53(1.10~2.12) 0.011 凝血酶时间/s 16.5±4.4 18.1±7.2 1.04(0.96~1.12) 0.335 凝血酶原活动度 86.0±13.2 67.5±23.2 0.96(0.93~0.99) 0.005
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表 3 毒蛇咬伤发生皮肤坏死性感染患者多因素分析
变量 β SE z P OR 截断值 -7.008 1.506 -4.654 < 0.001 0.001 SSS评分 0.723 0.194 3.726 < 0.001 2.060 血糖 0.239 0.106 2.252 0.024 1.270 D-二聚体 0.437 0.188 2.329 0.020 1.549
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