目的 探究影响CT引导下Hook-wire精准定位的风险因素,确定最佳定位管理策略,并制定Nomogram预测模型.方法 选择2018年7月-2022年11月在南京医科大学附属苏州医院行CT引导下Hook-wire穿刺定位的患者,按照7∶3的比例将患者随机分为训练集和验证集.分析患者的临床资料,采用单因素和多因素logistic回归分析筛选影响CT引导下Hook-wire精准定位的风险因素,根据风险因素构建Nomogram预测模型并进行拟合优度检验和临床决策曲线分析.结果 共纳入199例CT引导下Hook-wire穿刺定位患者,其中男72例、女127例,年龄25～83岁.训练集139例,验证集60例.训练集中精确定位患者70例(50.36％).多因素logistic回归分析结果显示,身高[OR=3.46,95％CI(1.44,8.35),P=0.006]、定位针垂直于水平面[OR=3.40,95％CI(1.37,8.43),P=0.008]、定位针垂直于皮肤表面切线[OR=6.01,95％CI(2.38,15.20),P＜0.001]、CT 扫描次数[OR=3.03,95％CI(1.25,7.33),P=0.014]、遮挡[OR=10.56,95％CI(1.98,56.48),P=0.006]是影响 CT 引导下Hook-wire精准定位的独立危险因素.基于上述危险因素建立CT引导下Hook-wire精准定位的Nomogram预测模型,其受试者工作特征曲线下面积(area under the curve,AUC)为0.843[95％CI(0.776,0.910)],校正曲线的预测值与实测值基本一致.利用验证集数据进行内部验证,AUC=0.854[95％CI(0.759,0.950)].决策曲线显示训练集阈值概率为8％～85％,验证集阈值概率为18％～99％时,具有较高的净获益值.结论 身高、定位针垂直于水平面、定位针垂直于皮肤表面切线、CT扫描次数、遮挡是影响CT引导下Hook-wire精准定位的独立危险因素,基于上述危险因素建立的Nomogram模型可准确评估和量化CT引导下Hook-wire精准定位的风险.
Risk factors for CT-guided Hook-wire accurate localization of isolated ground-glass nodules and the establishment of Nomogram prediction model
Objective To explore the influencing factors for Hook-wire precise positioning under CT guidance,determine the best positioning management strategy,and develop Nomogram prediction model.Methods Patients who underwent CT-guided Hook-wire puncture positioning in our hospital from July 2018 to November 2022 were selected.They were randomly divided into a training set and a validation set with a ratio of 7∶3.Clinical data of the patients were analyzed,and the logistic analysis was used to screen out the risk factors that affected CT-guided Hook-wire precise positioning for the training set.The Nomogram prediction model was constructed according to the risk factors,and the goodness of fit test and clinical decision curve analysis were performed.Results A total of 199 patients with CT-guided Hook-wire puncture were included in this study,including 72 males and 127 females,aged 25-83 years.There were 139 patients in the training set and 60 patients in the validation set.In the training set,70 patients were accurately located,with an incidence of 50.36％.Logistic regression analysis showed that height[OR=3.46,95％CI(1.44,8.35),P=0.006],locating needle perpendicular to the horizontal plane[OR=3.40,95％CI(1.37,8.43),P=0.008],locating needle perpendicular to the tangent line of skin surface[OR=6.01,95％CI(2.38,15.20),P＜0.001],CT scanning times[OR=3.03,95％CI(1.25,7.33),P=0.014],occlusion[OR=10.56,95％CI(1.98,56.48),P=0.006]were independent risk factors for CT-guided Hook-wire precise localization.The verification results of the Nomogram prediction model based on these independent risk factors showed that the area under the receiver operating characteristic curve(AUC)was 0.843[95％CI(0.776,0.910)],and the predicted value of the correction curve was basically consistent with the measured value.The AUC of the model in the validation set was 0.854[95％CI(0.759,0.950)].The decision curves showed that when the threshold probability was within the range of 8％-85％in the training set and 18％-99％in the validation set,there was a high net benefit value.Conclusion Height,the locating needle perpendicular to the horizontal plane,the locating needle perpendicular to the tangent line of skin surface,number of CT scans,and occlusion are independent risk factors for CT-guided Hook-wire accurate localization.The Nomogram model established based on the above risk factors can accurately assess and quantify the risk of CT-guided Hook-wire accurate localization.
万方数据
维普
