超声内镜下经鼻-肠梗阻导管置管术后预后不良的独立危险因素分析和列线图的构建及验证

Analysis of independent risk factors for poor prognosis after transnasal-intestinal obstruction catheterization under endoscopic ultrasound and construction and verification of nomogram

摘要:

目的 探讨影响超声内镜下经鼻-肠梗阻导管置管术后预后不良的独立危险因素，构建预测术后预后不良的列线图，并对列线图进行外部验证。方法 收集2019年2月－2022年2月于该院行超声内镜下经鼻-肠梗阻导管置管术的肠梗阻患者451例，根据患者的临床资料建立列线图模型，收集条件相同的2022年2月－2024年2月的194例患者作为外部验证组，对模型进行外部验证。观察术后30 d的恢复情况，将患者分为预后良好组和预后不良组，采用多因素Logistic回归模型，分析影响超声内镜下经鼻-肠梗阻导管置管术后预后不良的独立危险因素。采用R 3.6.3软件和RMS程序包，构建预测超声内镜下经鼻-肠梗阻导管置管术后预后不良风险的列线图模型。采用受试者操作特征曲线（ROC curve）和校准曲线评估模型的区分度和一致性。结果 预后不良组年龄大于预后良好组，C反应蛋白（CRP）、降钙素原（PCT）和中性粒细胞与淋巴细胞比值（NLR）水平高于预后良好组，住院时间长于预后良好组，糖尿病、腹痛进行性加重和应用激素比例高于预后良好组，体重指数（BMI）、术前白蛋白水平和术前营养支持比例低于预后良好组，差异均有统计学意义（P < 0.05）。多因素Logistic回归模型（引入水准为0.05，排除水准为0.107）结果显示：年龄 ≥ 68岁（OR＾ = 2.631，95%CI：1.927～3.593）、BMI < 22.31 kg/m²（OR＾ = 2.142，95%CI：1.436～3.195）、术前白蛋白 < 32.47 g/L（OR＾ = 1.962，95%CI：1.506～2.556）、无术前营养支持（OR＾ = 2.814，95%CI：1.401～5.654）是影响超声内镜下经鼻-肠梗阻导管置管术后预后不良的独立危险因素（P < 0.05）。列线图模型显示：年龄、BMI、术前白蛋白和无术前营养支持会增加相应权重，内部和外部验证结果提示模型一致性和区分度均较好。结论 年龄 ≥ 68岁、BMI < 22.31 kg/m²、术前白蛋白 < 32.47 g/L、无术前营养支持是超声内镜下经鼻-肠梗阻导管置管术后预后不良的影响因素，以此4项因素为基准建立的列线图模型，可靠且实用。

Abstract:

Objective To explore the independent risk factors influencing the poor prognosis after transnasal-intestinal obstruction catheterization under endoscopic ultrasound, construct a nomogram for predicting poor postoperative prognosis, and conduct external validation of the nomogram.Methods Clinical data of 451 patients with intestinal obstruction who underwent endoscopic ultrasound transnasal-intestinal obstruction catheterization from February 2019 to February 2022 were collected to establish a nomogram. Then, 194 sets of data with the same conditions from February 2022 to February 2024 were collected as the external validation group to validate the model externally. The recovery at 30 d after operation was observed and divided into good prognosis group and poor prognosis group. Multivariate Logistic regression model was used to analyze the independent risk factors influencing the poor prognosis after transnasal-intestinal obstruction catheterization under endoscopic ultrasound. Using R 3.6.3 software and the RMS package, a nomogram model for predicting the risk of poor prognosis after intestinal obstruction catheterization under endoscopic ultrasound was constructed.. The discrimination and consistency of the model were evaluated using receiver operator characteristic curve (ROC curve) and calibration curve.Results The patients in the poor prognosis group were older than those in the good prognosis group, the levels of C-reactive protein (CRP), procalcitonin (PCT) and neutrophil to lymphocyte ratio (NLR) were higher than those in the good prognosis group, the length of hospital stay was longer than that in the good prognosis group, and the proportion of diabetes, abdominal pain and hormone using were higher than those in the good prognosis group, body mass index (BMI), preoperative albumin level and preoperative nutritional support ratio were lower than those of the good prognosis group, with statistical significance (P < 0.05). Multivariate Logistic regression analysis (introduction level was 0.05, exclusion level was 0.107) showed that: age ≥ 68 years (OR＾ = 2.631, 95%CI: 1.927 ~ 3.593), BMI < 22.31 kg/m² (OR＾ = 2.142, 95%CI: 1.436 ~ 3.195), preoperative albumin < 32.47g/L (OR＾ = 1.962, 95%CI: 1.506 ~ 2.556) and preoperative nutritional non-support (OR＾ = 2.814, 95%CI: 1.401 ~ 5.654) were independent risk factors affecting the poor prognosis after endoscopic transnasal-intestinal obstruction catheterization (P < 0.05). The column nomogram showed that old age, low BMI, low preoperative albumin, and no preoperative nutritional support all increased their corresponding weights. Internal and external validation results indicated good consistency and discrimination of the model.Conclusion age ≥ 68 years, BMI < 22.31 kg/m², preoperative albumin < 32.47 g/L, and no preoperative nutritional support are all independent risk factors affecting the ineffective of intestinal obstruction catheterization under endoscopic ultrasound. The nomogram model established in this study based on these four factors has high reliability and practicality.