Construction and evaluation of nomogram model for recurrence risk of perimenopausal patients with abnormal uterine bleeding after hysteroscopy
Objective To analyze the risk factors for recurrence of abnormal uterine bleeding(AUB)after hys-teroscopy in patients with perimenopause,to construct a nomogram model based on the risk factors,and to evaluate the model's clinical predictive value for postoperative recurrence.Methods A prospective study was conducted on 200 pa-tients with perimenopausal AUB admitted to Puyang Huimin Hospital from January 2020 to August 2023.All patients underwent hysteroscopy surgery.Five patients were lost to follow-up within 6 months after surgery.Patients were divid-ed into a recurrence group(57 cases)and a non-recurrence group(138 cases).The general information and laboratory in-dicators of the two groups of patients were compared.The Lasso-Logistic regression equation was used to screen the fac-tors that affect the recurrence of AUB patients after hysteroscopy.The nomograph model was constructed using the R language software.The receiver operating characteristic(ROC)curve,calibration curve,and decision curve were drawn to evaluate the efficacy of the nomogram model for predicting the recurrence of AUB patients after hysterosco-py.Results The body mass index(BMI),AUB duration,endometrial thickness,proportion of postoperative use of Mi-rena,proportion of chronic disease history,and proportion of gynecological disease history in the recurrence group were(25.34±1.25)kg/m2,(62.62±5.58)d,(8.92±1.34)mm,15.79%,29.82%,and 24.56%,respectively,which were signifi-cantly higher than(21.65±1.34)kg/m2,(40.41±4.33)d,(6.78±1.01)mm,3.62%,14.49%,and 7.97%in the non-recurrent group;the serum vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF)were(23.55±5.12)pg/mL and(9.91±1.34)pg/mL,respectively,which were significantly lower than(30.34±4.68)pg/mL and(14.40±3.32)pg/mL in the non-recurrent group;the differences were statistically significant(P<0.05).The results of the Las-so-Logistic regression equation analysis showed that BMI,a history of chronic diseases,postoperative use of Mirena,se-rum levels of VEGF and bFGF were all factors that affected the recurrence of perimenopausal AUB patients after hyster-oscopy(P<0.05).Based on the analysis results of the Lasso-Logistic regression equation,a nomogram model for post-operative recurrence was constructed.The model evaluation and validation results showed that the area under the curve(AUC)of the model for predicting postoperative recurrence in perimenopausal area under the curve(AUC),patients af-ter hysteroscopy was 0.801(95%CI:0.733-0.870),and the predicted probability of postoperative recurrence was con-sistent with the actual probability.When the threshold probability was between 15%and 100%,the clinical net benefit rate was maximized.Conclusion BMI,history of chronic diseases,postoperative use of Mirena,serum VEGF,and bFGF are all influencing factors of the recurrence of perimenopausal AUB patients after hysteroscopy.Constructing a nomogram model based on these factors has good predictive value and positive clinical net benefit for postoperative re-currence,which can provide a reference for clinical prediction of postoperative recurrence and guide subsequent clini-cal decisions.
PerimenopausalAbnormal uterine bleedingHysteroscopyPostoperativeRecurrenceNomogram model
万方数据
维普
