摘要
目的 研究中青年急性阑尾炎(AA)患者中发生复杂性阑尾炎(CA)的危险因素,并建立和验证列线图预测模型.方法 对2022年1月至12月贵州省人民医院收治的252例接受腹腔镜阑尾切除术的中青年AA患者临床资料进行回顾性分析.根据术中探查结果CA患者101例,UA患者151例,分别作为CA组和UA组.并按照3:1的比例将252例中青年AA患者随机分配为训练集(n=189)和验证集(n=63).收集患者的临床资料[白细胞计数(WBC)、中性粒细胞计数(Neu)、中性粒细胞百分比(Neu％)、淋巴细胞计数(Lym)、血小板计数、C反应蛋白(CRP)、总胆红素、入院体温及腹痛时长病史],并计算中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR).在训练集中,使用Logistic回归分析影响AA患者发生CA的因素,并构建中青年AA患者发生CA的列线图预测模型,应用受试者工作特征(ROC)曲线评价预测模型的预测效能,使用校准曲线对预测模型进行一致性评价,并在验证集中进行内部验证.结果 在训练集中,CA组患者Neu、Neu％、CRP、入院体温、腹痛时长及NLR、PLR均高于UA组,Lym低于UA组,差异均有统计学意义(P＜0.05).在验证集中,CA组患者Neu％、CRP、总胆红素、腹痛时长及NLR、PLR均高于UA组,Lym低于UA组,差异均有统计学意义(P＜0.05).多因素Logistic回归分析提示NLR(X1)、CRP(X2)及入院体温(X3)为中青年AA患者发生CA的独立危险因素,得到的回归公式为Logit(P)=0.073X1+0.02X2+1.06X3-41.685.训练集中 ROC 曲线的曲线下面积(AUC)为 0.835(95％CI:0.769～0.901),内部验证集 AUC 为 0.837(95％CI:0.688～0.897).校准曲线显示预测概率接近观测概率.结论 构建的列线图能有效预测中青年AA患者发生CA的风险.中青年AA患者NLR、CRP及入院体温升高更容易发生CA,可能需要尽早接受手术干预.
Abstract
Objective To investigate the risk factors of complicated appendicitis(CA)in young and middle-aged patients with acute appendicitis(AA),and establish and verify the nomogram prediction model.Methods A retrospective analysis was performed on 252 young and middle-aged patients with AA who underwent laparoscopic appendectomy in Guizhou Provincial People's Hospital from January to December 2022.According to the intraoperative exploration results,there were 101 CA patients and 151 UA patients,who were respectively divided into the CA group and UA group.And they were randomly assigned to the training set(n=189)and the validation set(n=63)in a 3:1 ratio.Clinical data[white blood cell count(WBC),neutrophil count(Neu),neutrophil percentage(Neu％),lymphocyte count(Lym),platelet count,C-reactive protein(CRP),total bilirubin,admission temperature,and history of abdominal pain]of patients were collected,and neutrophil/lym-phocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)were calculated.In the training set,the factors affecting the occurrence of CA in AA patients were analyzed using Logistic regression analysis,and a nomogram prediction model for complicated appendicitis in young and middle-aged patients was constructed.The prediction efficiency of the prediction model was evaluated using receiver operating characteristic(ROC)curve,and the consistency of the prediction model was evaluated using a calibration curve.Internal verification was performed in the validation set.Results In the training set,the Neu,Neu％,CRP,admission temperature,duration of abdominal pain and,NLR,PLR of patients in the CA group were higher than those in the UA group,and Lym was lower than that in the UA group,the differences were statistically significant(P＜0.05).In the validation set,the Neu％,CRP,total bilirubin,duration of abdominal pain and NLR,PLR of patients in the CA group were higher than those in the UA group,and Lym was lower than that in the UA group,the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis indicated that NLR(Xl),CRP(X2)and body temperature at admission(X3)were independent risk factors for CA in young and middle-aged patients with AA,and the regression equation was Logit(P)=0.073X1+0.02X2+1.06X3-41.685.The area un-der the curve(AUC)of the ROC curve in the training set was 0.835(95％CI:0.769-0.901),and the AUC in the internal validation set was 0.837(95％CI:0.688-0.897).The calibration curve showed that the prediction probability was close to the observation probability.Conclu-sion The constructed nomogram can effectively predict the risk of CA in young and middle-aged AA patients,and can provide reference for clin-ical decisions.CA is more likely to occur in young and middle-aged AA patients with elevated NLR,CRP and body temperature at admission,which may require early surgical intervention.
维普
万方数据