妇科恶性肿瘤术后肢体淋巴水肿风险预测模型的构建及验证  

Establishment of risk prediction model for limb lymphedema after gynecologic malignant tumor surgery and its validation

作　　者：叶伟娟 吕清媛 甘雅丽 郑聪霞 张丽香 郑颖 王慧丽 程晓燕 YE Weijuan;LYU Qingyuan;GAN Yali;ZHENG Congxia;ZHANG Lixiang;ZHENG Ying;WANG Huili;CHENG Xiaoyan(Lishui Maternal and Child Health Hospital,Lishui 323000,Zhejiang,China)

机构地区：[1]丽水市妇幼保健院,浙江丽水323000

出　　处：《护士进修杂志》2023年第21期1927-1931,共5页Journal of Nurses Training

基　　金：浙江省医药卫生科技计划项目(编号:2021KY1247)。

摘　　要：目的探究妇科恶性肿瘤术后出现下肢淋巴水肿的危险因素,以此构建风险预测模型并行验证。方法回顾性分析2018年1月-2021年7月于本院行手术治疗的324例妇科恶性肿瘤患者,根据患者术后6个月内下肢淋巴水肿的发生情况,分为无水肿组与水肿组,收集患者的相关资料,并以单因素和多因素logistic回归分析影响患者发生相关并发症的独立影响因素,并以此构建风险预测模型。另选取2021年8月-2022年3月于本院行手术治疗的108例妇科恶性肿瘤患者作为外部验证,以受试者工作特性曲线(ROC)评估风险预测模型的预测价值,采用Hosmer-Lemeshow检验判断模型的拟合优度。结果324例行手术治疗的妇科恶性肿瘤患者中,有84例在术后6个月内出现下肢淋巴水肿,下肢淋巴水肿发生率为25.93%。单因素和多因素分析结果显示,年龄、FIGO分期、术后放疗、淋巴结清扫、术后引流时间、合并高血压、合并糖尿病均为影响妇科恶性肿瘤患者术后发生下肢淋巴水肿的独立危险因素(P<0.05)。风险预测模型:Logit(P)=-4.440+0.918×(年龄>60岁)+2.010×(FIGO分期Ⅳ期)+0.820×(术后放疗)+1.260×(淋巴结清扫)+0.620×(术后引流时间)+1.194×(合并高血压)+0.998×(合并糖尿病),风险预警模型ROC曲线下面积(AUC)为0.798(95%CI:0.748~0.848),灵敏度为81.7%,特异度为63.2%,Hosmer-Lemeshow拟合检验显示,χ2=12.354,P=0.136,模型拟合效度好,预测价值高。模型外部验证敏感性81.5%,特异性86.4%,总准确率85.2%。结论年龄、FIGO分期、术后放疗、淋巴结清扫、术后引流时间、合并高血压、合并糖尿病均为影响妇科恶性肿瘤患者术后发生下肢淋巴水肿的独立危险因素,以此构建风险预测模型具有一定的预测效能。Objective To explore the risk factors of lower limb lymphedema after gynecologic malignant tumor surgery,and to construct a risk prediction model and verify it.Methods A retrospective analysis was made on 324 patients with gynecologic malignant tumors who were operated in our hospital from January 2018 to July 2021.According to the occurrence of lymphedema in lower limbs within 6 months after surgery,the patients were divided into non edema group and edema group,and relevant data of patients were collected.Single factor and multi factor logistic regression analysis was used to analyze the independent influencing factors affecting the occurrence of related complications of patients,and a risk prediction model was constructed.In addition,108 patients with gynecologic malignant tumors who were operated in our hospital from August 2021 to March 2022 were selected as external validation.The predictive value of the risk prediction model was evaluated by the subject's work characteristic curve(ROC),and the goodness of fit of the model was judged by the Hosmer-Lemeshow test.Results Among 324 patients with gynecologic malignant tumors,84 patients had lower limb lymphedema within 6 months after surgery,and the incidence of lower limb lymphedema was 25.93%.Univariate and multivariate analysis showed that there were all independent risk factors for postoperative lymphedema of lower limbs in patients with gynecological malignancies between the two groups in age,FIGO stage,postoperative radiotherapy,lymph node dissection,postoperative drainage time,hypertension,and diabetes(P<0.05).Risk prediction model:Logit(P)=-4.440+0.918×(Age>60 years)+2.010×(FIGO PhaseⅣ)+0.820×(Postoperative radiotherapy)+1.260×(Lymph node dissection)+0.620×(Postoperative drainage time)+1.194×(Combined with hypertension)+0.998×(combined with diabetes),the area under the ROC curve(AUC)of the risk early warning model was 0.798(95%CI was 0.748-0.848),the sensitivity was 81.7%,the specificity was 63.2%,and the Hosmer was Lemeshow fitting test shows t

关 键 词：妇科恶性肿瘤 淋巴水肿 危险因素 预测模型 

分 类 号：R473.71[医药卫生—护理学] R473.73[医药卫生—临床医学]