基于CT征象的复杂性阑尾炎危险因素分析及预测模型的构建  

Analysis of risk factors and construction of prediction model for complicated appendicitis based on CT signs

作　　者：赵林芬[1] 汤萍 李可[2] 陈孝生[1] 王江[1] ZHAO Linfen;TANG Ping;LI Ke;CHEN Xiaosheng;WANG Jiang(Department of Radiology,Changzhou Wujin Hospital of TCM,Changzhou 213161,China;Department of Pathology,Changzhou Wujin Hospital of TCM,Changzhou 213161,China)

机构地区：[1]江苏省常州市武进中医医院放射科,江苏常州213161 [2]江苏省常州市武进中医医院病理科,江苏常州213161

出　　处：《中国中西医结合影像学杂志》2024年第3期267-271,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:通过比较复杂性阑尾炎(CA)与非复杂性阑尾炎(UCA)的9种CT征象,筛选CA的危险因素并建立模型。方法:收集403例急性阑尾炎患者的临床和CT资料,93例为CA组,310例为UCA组。观察比较2组患者的9种CT征象。以7∶3比例将403例患者随机分为训练集(283例)与验证集(120例)。以训练集中CA为因变量,采用单因素及多因素logistic回归分析筛选CA的危险因素并构建模型,绘制ROC曲线及校准图评价该模型的区分度和校准度。在原始数据集采用Bootstrap法行内部验证,验证集行外部验证。结果:单因素及多因素logistic回归分析显示,腔内粪石、阑尾周围积液、腔内不连续气体及阑尾周围渗出是CA的独立危险因素,OR值分别为2.30、4.01、5.06和5.97。以上述4个变量构建CA预测模型,AUC为0.88(95%CI 0.64~0.97),校准曲线拟合优度较好(P>0.05)。模型内部验证计算得出AUC为0.88(95%CI 0.84~0.91)。模型外部验证计算得出AUC为0.88(95%CI 0.71~0.96),校准曲线拟合优度较好(P>0.05)。结论:基于CT征象建立的预测模型诊断CA具有较高价值。Objective:By comparing 9 CT signs of complicated appendicitis(CA)and uncomplicated appendicitis(UCA),to screen the risk predictors of CA for the models’establishment.Methods:Clinical and CT data of 403 patients with acute appendicitis were collected.93 patients were in the CA group and 310 patients were in the UCA group.9 CT signs of two groups were observed and compared.403 patients were randomly divided into a training cohort(283 cases)and a validation cohort(120 cases)at a ratio of 7∶3.Univariate and multivariate logistic regression analysis and model construction were carried out on the training cohort.ROC curve and calibration curve were drawn to evaluate the discrimination and calibration degree of the model.Bootstrap method on the original data set was used for internal verification.The validation cohort was used for external verification.Results:Univariate and multivariate logistic regression analysis showed that appendiceal fecalith,periappendiceal effusion,appendiceal discontinuous pneumatosis,periappendiceal exudation were independent predictors of CA(OR=2.30,4.01,5.06,5.97).The prediction model was constructed with the abvoe 4 variables.The AUC of the model was 0.88(95%CI 0.64~0.97),and the calibration curve had a good goodness of fit(P>0.05).The AUC calculated by internal verification of the model was 0.88(95%CI 0.84~0.91),the AUC calculated by external verification was 0.88(95%CI 0.71~0.96),and the calibration curve had a good goodness of fit(P>0.05).Conclusion:The prediction model based on CT signs is valuable in diagnosing CA.

关 键 词：复杂性阑尾炎 体层摄影术 X线计算机 预测模型 危险因素 

分 类 号：R656.8[医药卫生—外科学] R816.5[医药卫生—临床医学]