结肠息肉内镜切除术后并发消化道出血的危险因素分析与预测模型建立-现代医学

结肠息肉内镜切除术后并发消化道出血的危险因素分析与预测模型建立

单位：泰州市人民医院消化内科, 江苏泰州 225300

分类号：R735.3

出版年·卷·期（页码）：2020·48·第一期（97-102）

摘要：

目的： 探讨结肠息肉内镜切除术后并发消化道出血的危险因素分析与风险列线图预测模型的建立。方法： 选取2015年7月-2019年5月我院3 210例结肠息肉内镜切除术治疗的结肠息肉患者，收集患者临床资料进行回顾性分析。调取临床病例信息及一般临床资料，使用Logistic回归分析筛选结肠息肉内镜切除术后并发消化道出血的独立危险因素。然后纳入筛选出的独立危险因素建立列线图预测模型，并对模型的预测性及准确度进行验证。方法： 通过对两组患者基本资料及内镜下切除术中相关资料做Logistic回归分析可知，性别、高血脂、高血压、吸烟、术者职称、术中使用钛夹、切除息肉数、术中出血、息肉分叶及息肉外观为结肠息肉内镜切除术后发生消化道出血的独立危险因素，具有统计学差异（P<0.05）。基于筛选出的独立危险因素建立了预测结肠息肉内镜切除术后并发消化道出血的列线图模型。并对该模型进行验证，预测值同实测值基本一致，说明本研究的列线图预测模型具有较好的预测能力，同时本研究使用Bootstrap 内部验证法对结肠息肉内镜切除术后并发消化道出血模型进行验证，C-index指数高达0.853（95%CI：0.828~0.878），说明本研究列线图模型具有良好的精准度和区分度。方法： 结肠息肉内镜切除术后并发消化道出血及时考虑性别、高血压、吸烟、消化道出血史、术者职称、术中使用钛夹、切除息肉数、术中出血、息肉分叶及息肉外观等因素综合评估结肠息肉内镜切除术后并发消化道出血的概率。

Objective: To investigate the risk factors analysis and risk line graph prediction model of gastrointestinal bleeding after endoscopic resection of colon polyps. Methods: A total of 3,210 patients with colon polyps treated with endoscopic resection of colon polyps from July 2015 to May 2019 were enrolled. The clinical data of the patients were collected for retrospective analysis. The clinical case information and general clinical data were retrieved. Logistic regression analysis was used to screen the independent risk factors of gastrointestinal bleeding after endoscopic resection of colon polyps. Then, the independent risk factors selected were used to establish a nomogram prediction model, and the predictability and accuracy of the model were verified.Results: Logistic regression analysis was performed on the basic data of the two groups of patients and related data in endoscopic resection. Gender, hyperlipidemia, hypertension, smoking, professional title of operators, intraoperative titanium clip, number of polyps removed, intraoperative Hemorrhage, polyp lobulation and polyp appearance were independent risk factors for gastrointestinal bleeding after endoscopic resection of colon polyps with a statistical difference (P<0.05). A nomogram model for predicting gastrointestinal bleeding after endoscopic resection of colon polyps was established based on the selected independent risk factors. The model was validated, and the predicted values were basically consistent with the measured values, indicating that the nomogram prediction model of this study had a good predictive ability. At the same time, this study used the Bootstrap internal verification method to treat the digestive tract after endoscopic resection of colon polyps. The bleeding model was validated, and the C-index index was as high as 0.853 (95% CI:0.828~0.878), indicating that the lining model of this study had good precision and discrimination. Conclusion: It is of high clinical value to evaluate the probability of gastrointestinal bleeding complicated with endoscopic resection of colon polyps by considering sex, hypertension, smoking, history of gastrointestinal bleeding, professional title of operators, using titanium clip during operation, number of polyps resected, bleeding during operation, lobulation of polyps and appearance of polyps.

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