食管癌放疗患者衰弱综合征危险因素分析及风险预测模型的构建  

Analysis of risk factors and construction of predictive model for frailty syndrome in patients with radiotherapy for esophageal cance

作　　者：周菊 闵旭红 桑莹莹 李兵 朱敏 ZHOU Ju;MIN Xuhong;SAN Yingying;LI Bing;ZHU Min(Department of Radiotherapy,Anhui Pulmonary Hospital,Hefei 230022,China)

机构地区：[1]安徽省胸科医院肿瘤放疗科,安徽合肥230022 [2]安徽省胸科医院护理部,安徽合肥230022 [3]安徽省胸科医院放疗科,安徽合肥230022

出　　处：《安徽医学》2024年第10期1227-1233,共7页Anhui Medical Journal

基　　金：安徽省临床重点专科建设项目(编号:皖卫函【2023】320)。

摘　　要：目的分析食管癌放疗患者衰弱综合征的危险因素并构建风险预测模型。方法采用便利抽样方法,选择2020年4月至2023年3月在安徽省胸科医院住院放疗的140例食管癌患者为研究对象。采用单因素分析和logistic回归分析食管癌放疗患者发生衰弱综合征的危险因素,构建风险预测模型,采用Hosmer-Lemeshow检验衰弱模型拟合优度,受试者工作特征(ROC)曲线检验模型预测效果。结果140例食管癌放疗患者衰弱综合征发生率为43.57%(61/140)。年龄、同步化疗、吞咽功能、焦虑、抑郁、营养风险和自我管理水平是衰弱综合征发生的独立危险因素(P<0.05)。根据多因素分析中有意义的变量构建回归拟合方程为Logit(P)=-10.374+0.125×年龄+1.334×同步放化疗+0.593×吞咽功能+0.967×HADS-A+1.038×HADS-D+1.271×营养风险-0.057×自我管理水平。Hosmer-Lemeshow检验结果提示,该风险预测模型具有良好的拟合度(χ^(2)=6.974,P=0.539)。模型验证结果显示,ROC曲线下面积为0.899,95%CI为0.847~0.952,约登指数为0.717,最佳临界值为0.446,灵敏度和特异度分别为86.9%和84.8%,实际应用正确率为85.0%。结论构建的风险预测模型具有良好的预测效果,可为临床医护人员早期有效识别食管癌放疗患者发生衰弱综合征风险及制定预防性干预方案提供参考依据。Objective To analyze the risk factors of asthenic syndrome in patients with radiotherapy for esophageal cancer,and estab⁃lish a risk prediction model.Methods A total of 140 patients with esophageal cancer who received radiotherapy in a specialized hospital in Anhui province from April 2020 to March 2023 were selected as the study objects by convenient sampling method.Univariate analysis and lo⁃gistic regression were used to analyze the risk factors for developing frailty syndrome in patients with esophageal cancer radiotherapy,and the risk prediction model was constructed.Hosmer-Lemeshow was used to test the goodness of fit of the frailty model,and receiver operating char⁃acteristic(ROC)curve was used to test the prediction effect of the model.Results The incidence of asthenic syndrome in 140 patients with ra⁃diotherapy for esophageal cancer was 43.57%(62/140).Age,concurrent chemotherapy,swallowing function,anxiety,depression,nutritional risk and self-management level were independent risk factors for the development of the debilitating syndrome(P<0.05).The regression fitting equation was constructed according to the meaningful variables in the multivariate analysis as Logit(P)=-10.374+0.125×age+1.334×concur⁃rent chemoradiotherapy+0.593×swallowing function+0.967×HADS-A+1.038×HADS-D+1.271×nutritional risk-0.057×self-administered level.Hosmer-Lemeshow test results indicated that the risk prediction model had a good fit(χ^(2)=6.974,P=0.539).Model verification results showed that the area under ROC curve was 0.899,95%CI was(0.847~0.952),the Yodon index was 0.717,the optimal critical value was 0.446,the sensitivity and specificity was 86.9%and 84.8%,respectively,and the actual application accuracy was 85.0%.Conclusion The estab⁃lished risk prediction model has a good prediction effect,which can provide a reference for clinical staff to identify the risk of debilitating syn⁃drome in patients with esophageal cancer radiotherapy in early stage and make preventive intervention plans.

关 键 词：食管癌 放疗 衰弱综合征 风险因素 预测模型 

分 类 号：R735.1[医药卫生—肿瘤]