肺癌患者胸腔镜术后心肺并发症预测模型的建立与分析  

Establishment and analysis of prediction model of cardiopulmonary complications of patients with lung cancer after thoracoscopic surgery

作　　者：王新[1] 王炯杰[1] 王雷[1] 韩亮[2] 潘雪峰[1] 张淼[1] WANG Xin;WANG Jiongjie;WANG Lei;HAN Liang;PAN Xuefeng;ZHANG Miao(Department of Thoracic Surgery,Xuzhou Central Hospital,Jiangsu Xuzhou 221009,China;Department of Oncology,Xuzhou Central Hospital,Jiangsu Xuzhou 221009,China)

机构地区：[1]徐州市中心医院胸外科,江苏徐州221009 [2]徐州市中心医院肿瘤内科,江苏徐州221009

出　　处：《现代肿瘤医学》2022年第13期2351-2356,共6页Journal of Modern Oncology

基　　金：国家自然科学基金面上项目(编号:81772479)。

摘　　要：目的:探讨肺癌患者胸腔镜术后心肺并发症的影响因素,建立列线图预测模型,并对其敏感性与可靠性进行验证。方法:回顾性分析2017年至2020年期间我院胸外科接受胸腔镜手术治疗的242例肺癌患者的临床数据,根据是否出现术后心肺并发症分为并发症组(55例)和无并发症组(187例)。采用单因素及多因素Logistic回归模型分析心肺并发症的危险因素,并构建列线图预测模型。编制校准曲线以确定模型的一致性,通过时间相关的受试者工作特征曲线(receiver operating characteristic curve,ROC)、决策曲线分析(decision curve analysis,DCA)评价该列线图模型的预测效果。结果:单因素分析显示,性别、年龄、高血压、糖尿病、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)和术中出血量均是肺癌患者胸腔镜术后心肺并发症的影响因素(P<0.05)。多因素回归分析显示,年龄、高血压、糖尿病、COPD和术中出血量是术后心肺并发症的独立风险因素(P<0.05)。校准曲线表明该模型拟合较好;ROC曲线下面积(area under curve,AUC)为0.817(95%CI:0.757~0.877),灵敏度为89.09%,特异度为60.43%;DCA结果表明该模型具有较高的净获益水平。结论:本研究建立了列线图模型,对肺癌患者胸腔镜术后心肺并发症有较好的预测能力及良好的临床应用价值。Objective:To explore the factors affecting the cardiopulmonary complications of patients with lung cancer after thoracoscopic surgery,a nomogram prediction model was established and verified by its sensitivity and reliability.Methods:The clinical data of 242 patients with lung cancer who underwent thoracoscopic surgery in thoracic surgery between 2017 to 2020 were analyzed retrospectively.According to postoperative cardiopulmonary complications,who were divided into complication group(55 cases)and non-complication group(187 cases).Univariate and multivariate Logistic regression models were used to analyze the risk factors of cardiopulmonary complications and a nomogram prediction model was established.The calibration curve was compiled to determine the consistency of the model,and the prediction effect of the nomogram model was evaluated by time-dependent receiver operating characteristic curve(ROC)and decision curve analysis(DCA).Results:Univariate analysis showed that gender,age,hypertension,diabetes,COPD and surgical bleeding were influencing factors for postoperative cardiopulmonary complications(P<0.05).Multivariate regression analysis showed that age,hypertension,diabetes,COPD and intraoperative blood loss were independent risk factors for postoperative cardiopulmonary complications(P<0.05).The calibration curve showed that the model fits well.The area under the ROC curve(AUC)was 0.817(95%CI:0.757~0.877),the sensitivity was 89.09%,and the specificity was 60.43%.DCA results showed that the model had a good performance.Conclusion:A nomogram model was established in this study,which could predict the cardiopulmonary complications of lung cancer patients after thoracoscopic surgery and have good clinical application value.

关 键 词：肺癌 胸腔镜 并发症 预测模型 

分 类 号：R734.2[医药卫生—肿瘤]