早期胃癌患者ESD术后并发肺炎相关因素分析及风险模型预测  

Related Factors and Risk Model Prediction of Pneumonia After ESD in Patients with Early Gastric Cancer

作　　者：刘晓燕 汤海涛[1] 王修中[1] 潘宏年[1] LIU Xiaoyan;TANG Haitao;WANG Xiuzhong;PAN Hongnian(Department of Gastroenterology,Lu’an People’s Hospital,Lu’an 237000,China)

机构地区：[1]六安市人民医院消化科

出　　处：《肿瘤防治研究》2019年第10期916-920,共5页Cancer Research on Prevention and Treatment

摘　　要：目的探讨早期胃癌患者内镜黏膜下剥离(ESD)术后并发肺炎的相关因素及风险模型预测。方法选取2016年5月—2019年2月六安市人民医院171例接受治疗的早期胃癌患者,所有患者均接受ESD术,采用Logistic回归分析筛选早期胃癌患者ESD术后并发肺炎的独立危险因素。根据筛选出的独立危险因素建立列线图预测模型,并对模型的准确度及预测性进行验证。结果高血脂(OR=0.216,95%CI:0.052~1.274)、抗菌药物使用情况(OR=12.591,95%CI:3.242~48.899)、是否入住ICU(OR=12.591,95%CI:0.015~0.281)、是否吞咽障碍(OR=0.217,95%CI:0.048~0.972)、浸润深度(OR=0.12,95%CI:0.025~0.572)、口腔护理(OR=8.976,95%CI:2.291~35.16)及留置胃管(OR=3.906,95%CI:1.097~13.907)为ESD术后并发肺炎的独立危险因素,基于筛选出的7项独立危险因素,建立预测ESD术后并发肺炎风险的列线图模型。通过对该模型进行验证表明:预测值和观察值基本一致,说明本研究的列线图预测模型具有较好的预测能力,同时使用Bootstrap部验证法对ESD术后并发肺炎的列线图模型进行验证,C-index指数高达0.937(95%CI:0.929~0.945),说明列线图模型有良好的精准度和区分度。结论对行ESD术后的早期胃癌患者及时考虑高血脂、抗菌药物使用情况、是否入住ICU、是否吞咽障碍、浸润深度、口腔护理及留置胃管等因素综合评估ESD术后肺炎的发生率,能提高对早期胃癌患者ESD术后并发肺炎的诊断效能。Objective To investigate the related factors and risk model prediction of pneumonia in patients with early gastric cancer after ESD.Methods We enrolled 171 patients with early gastric cancer who underwent endoscopic submucosal dissection(ESD)from May 2016 to February 2019.Logistic regression analysis was used to screen independent risk factor of pneumonia in patients with early gastric cancer after ESD.Then,based on the selected independent risk factors,we established a nomogram prediction model and verified the accuracy and predictability of the model.Results Hyperlipidemia,antibacterial usage,ICU treatment or not,swallowing disorder,infiltration depth,oral care and indwelling gastric tube were independent risk factors for pneumonia after ESD.Based on the selected seven independent risk factors,we established a nomogram model to predict the risk of pneumonia after ESD.The validation of the model showed that the predicted values and the observed values were basically consistent,indicating that the nomogram prediction model had a good predictive ability.We used the Bootstrap internal verification method to validate the model.The C-index index was 0.937(95%CI:0.929-0.945),indicating that the model had good precision and discrimination.Conclusion For patients with early gastric cancer,timely consideration of hyperlipidemia,antibiotic usage,ICU treatment or not,dysphagia,depth of infiltration,oral care and indwelling gastric tube could improve the diagnostic efficacy for the incidence of pneumonia after ESD.

关 键 词：早期胃癌 内镜黏膜下剥离 肺炎 风险模型预测 

分 类 号：R735.2[医药卫生—肿瘤]