关键词: 抗磷脂抗体, 狼疮抗凝物, 抗磷脂综合征, 系统性红斑狼疮, 自身免疫性疾病, 列线图模型, 血栓

Abstract:

Objective To analyze the influencing factors of thrombosis in patients with autoimmune diseases and construct a nomogram model，and to evaluate its clinical application value. Methods A total of 250 patients with autoimmune diseases from the General Hospital of Western Theater Command of People's Liberation Army from January 2021 to December 2023 were enrolled，including 17 cases of antiphospholipid syndrome（APS） and 233 cases of systemic lupus erythematosus（SLE）. All the patients were randomly classified into a training set and a validation set at a ratio of 7︰3. The clinical data and laboratory determination results were collected. All the patients were followed up for 3 years and were classified into thrombosis group（40 cases） and non-thrombosis group（210 cases） based on the occurrence of thrombosis. LASSO regression analysis was used to screen variables and construct nomogram model. The clinical value of the nomogram model was evaluated by receiver operating characteristic（ROC） curves，calibration curves and decision curves. Results In the training set，the proportion of patients >50 years old，the proportion of patients with hypertension，the positive rate of lupus anticoagulant（LA） and activated partial thromboplastin time（APTT）in thrombosis group were higher than those in non-thrombosis group（P<0.05）. Five influencing factors（age，hypertension，lupus nephritis，APTT，LA）were screened out by the LASSO regression model，and a nomogram model was constructed. In the training set and validation set，the areas under curves（AUC） of the nomogram model for predicting thrombosis in APS and SLE patients were 0.79 and 0.81，respectively. The predicted probability of thrombosis in APS and SLE patients was close to the actual probability（Hosmer-Lemeshow χ² values were 8.615 and 12.192，P>0.05）. Within the threshold probability range of 0.1-0.7，the nomogram model had a good net benefit，with the maximum net benefit being 0.18. Conclusions The nomogram model constructed based on age，hypertension，lupus nephritis，APTT and LA for predicting thrombosis in APS and SLE patients has high clinical value and can play a role in the prediction and identification of thrombotic events in APS and SLE patients.

Key words: Antiphospholipid antibody, Lupus anticoagulant, Antiphospholipid syndrome, Systemic lupus erythematosus, Autoimmune disease, Nomogram model, Thrombosis