大肠黑变病患者腺瘤性息肉发病的危险因素分析及临床预测模型构建  

Risk factors analysis and clinical prediction model construction of adenomatous polyps in patients with colorectal melanoma melanosis coli

作　　者：张雪 唐祚 叶欣 文黎明 ZHANG Xue;TANG Zuo;YE Xin;WEN Li-ming(Department of Gastroenterology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院消化内科,646000

出　　处：《现代消化及介入诊疗》2024年第2期126-134,共9页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：四川省医学会科研课题(S21074);四川省科技计划资助(2023YFG0262)。

摘　　要：目的探究大肠黑变病(MC)发生腺瘤性息肉的危险因素,构建大肠黑变病发生腺瘤性息肉的风险预测模型并进行验证。方法回顾性分析四川绵阳四○四医院结肠镜检查诊断为大肠黑变病患者的临床资料。收集其相关危险因素,包括性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病病史、黑变程度等资料,应用R语言建立预测腺瘤性息肉组发生风险的列线图模型,通过C指数、校准曲线和决策曲线分析(DCA)进行模型的评价,用Bootstrap法进行模型内部验证。结果性别、黑变程度、同型半胱氨酸、HbA1c、TSH、大便隐血、胆囊结石或息肉、幽门螺杆菌感染是大肠黑变病患者发生腺瘤性息肉的独立影响因素。训练集和验证集Hosmer Lemeshow拟合优度检验P值分别为0.157和0.179,提示模型拟合良好。训练集和验证级的阈值概率均为0%~100%时,可能对大肠黑变病患者进行临床干预后受益。结论由上述危险因素建立的风险模型区分度良好、模型拟合良好,可为临床决策提供参考。Objective To explore the risk factors for the occurrence of adenomatous polyps in melanosis coli(MC),and to construct and validate a risk prediction model for the occurrence of adenomatous polyps in MC.Methods The clinical data of patients with melanosis coli who underwent colonoscopy in our hospital were retrospectively analyzed.The related risk factors,including gender,age,smoking history,drinking history,hypertension history,diabetes history,melanosis degree and so on,were collected.Establish a column chart model for predicting the risk of adenomatous polyps using R language,evaluate the model through C-index,calibration curve,and decision curve analysis(DCA),and validate the model internally using Bootstrap method.Results Gender,degree of melanosis,homocysteine,HbA1c,TSH,fecal occult blood,gallstones or polyps,HP infection were the independent influencing factors of adenomatous polyps in patients with melanosis of large intestine.The model had a good discrimination in predicting the risk of adenomatous polyps in patients with colorectal melanosis.Hosmer Lemeshow goodness of fit test showed that the P values of the training set and the validation set were 0.157 and 0.179,respectively(both<0.05),indicating that the model fitted well.When the threshold probability of the training set and the validation level were both 0%to 100%,patients with melanosis of the colon may benefit from clinical intervention.Conclusion The risk model established by the above risk factors has good discrimination and good fit,which can provide reference for clinical decision-making.

关 键 词：大肠黑变病 腺瘤性息肉 危险因素 预测模型 

分 类 号：R574[医药卫生—消化系统]