基于Nomogram图预测甲状腺术后低钙血症的模型建立及临床价值  

Model establishment and clinical value of predicting hypocalcemia after thyroid surgery based on Nomogram

作　　者：丁伟 吕帝 刘小华 胡书群 DING Wei;LYU Di;LIU Xiao-hua;HU Shu-qun(Department of General Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Department of Nail and Breast Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Department of Medical Imaging,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;Emergency Medical Laboratory,Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院普通外科,江苏徐州221006 [2]徐州医科大学附属医院甲状腺乳腺外科,江苏徐州221006 [3]徐州医科大学附属医院医学影像科,江苏徐州221006 [4]徐州医科大学急诊医学实验室,江苏徐州221002

出　　处：《中国现代普通外科进展》2023年第7期531-536,共6页Chinese Journal of Current Advances in General Surgery

基　　金：江苏省政府重点研发计划面上项目(BE2017641);吴阶平医学基金会临床科研专项资助基金(320.6750.2022-19-6)。

摘　　要：目的:基于Nomogram图建立预测甲状腺术后发生低钙血症的模型,并探究该模型的临床价值。方法:纳入徐州医科大学附属医院2020年11月—2021年11月收治的247例甲状腺手术患者,按照其术后低钙血症发生情况,将患者分别纳入发生组、未发生组。运用单因素和多因素Logistic回归模型,分析影响患者发生低钙血症的相关因素。以独立危险因素构建二元Logistic回归并建立Nomogram图预测模型,并纳入74例甲状腺手术患者,验证模型的效能。结果:247例患者中,共有82例(33.20%)发生低钙血症。多因素Logistic回归模型示,女性、手术时间≥100 min、甲状旁腺腺体损伤均为影响甲状腺术后发生低钙血症的独立危险因素,单侧腺叶加峡部加对侧部分切除为保护性因素(P<0.05)。将基于独立危险因素建立的Nomogram图应用于训练集行内部验证,AUC为0.869(95%CI:0.820~0.918);验证集外部验证结果显示,AUC为0.876(95%CI:0.796~0.956),校正曲线均接近理想曲线,预测概率与实测值基本一致。结论:甲状腺术后患者低钙血症发生风险较高,且性别、手术时间、甲状旁腺腺体损伤情况、切除范围均与低钙血症的发生有关,结合上述因素构建的Nomogram图模型的预测准确性良好,能够为低钙血症的防治提供客观参考。Objective:To establish a model for predicting hypocalcemia in patients after thyroid surgery based on Nomogram and explore its clinical value.Methods:247 cases of thyroid surgery patients admitted to the Department of thyroid and breast surgery,Affiliated Hospital of Xuzhou Medical University from November 2020 to November 2021 were divided into two groups according to the incidence of hypocalcemia after operation.Using univariate and Logistic multivariate regression models,the related factors affecting hypocalcemia were analyzed.Using independent risk factors,a binary Logistic regression model and a Nomogram prediction model were established,and 74 patients undergoing thyroid surgery were included to verify the effectiveness of the model.Results:Of the 247 patients,82 cases(33.20%)developed hypocalcemia.Multivariate Logistic regression model showed that female,operation time≥100 min and parathyroid gland injury were independent risk factors for hypocalcemia after thyroid surgery,and unilateral lobectomy and isthmus and contralateral partial resection were protective factors(P<0.05).The Nomogram chart based on independent risk factors was applied to the internal verification of the training set,and the AUC was 0.869(95%CI:0.820-0.918).The external verification results of the verification set show that AUC was 0.876(95%CI:0.796-0.956),the calibration curves were all close to ideal curves,and the predicted probability was basically consistent with the measured values.Conclusion:The risk of hypocalcemia is high in patients after thyroid surgery,and gender,operation time,parathyroid gland injury and resection range are all related to hypocalcemia.The Nomogram model constructed by combining the above factors has good prediction accuracy and can provide objective reference for the prevention and treatment of hypocalcemia.

关 键 词：Nomogram图 甲状腺手术 低钙血症 预测模型 

分 类 号：R653[医药卫生—外科学]