联合腹部CT图像特征和临床指标的列线图模型对腹内高压评估的临床研究  

Development of a predictive nomogram model integrating abdominal CT imaging and clinical parameters for assessing the risk of elevated intra-abdominal pressure

作　　者：张敏伟 翟天旭 张子秋 王驰 刘胜中 李德春 Zhang Minwei;Zhai Tianxu;Zhang Ziqiu;Wang Chi;Liu Shengzhong;Li Dechun(Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China;Department of Radiology,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州医科大学徐州临床学院,江苏省221009 [2]徐州市中心医院放射科,江苏省221009

出　　处：《中华消化病与影像杂志（电子版）》2024年第6期549-554,共6页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的分析并确定能够预测腹内高压的CT图像特征和临床指标,以便建立可靠的腹内高压(IAH)列线图预测模型。方法收集了2021年1月至2023年3月于徐州市中心医院重症监护室住院并行膀胱测压及腹部CT检查的患者。研究共纳入58例患者,其中IAH组25例,非IAH组33例。收集患者的临床指标和腹部CT图像特征,并使用logistic回归对临床指标和CT图像特征进行统计学分析,以此结果构建列线图预测模型,并对该模型进行验证及临床价值判断。结果研究发现腹壁纵横比(P=0.043;OR=3.102;95%CI 1.034~9.307)、腹腔腹壁纵径比(P=0.002;OR=12.105;95%CI 2.575~56.897)是IAH独立影响因素。列线图预测模型的AUC为0.925,校正曲线显示列线图模型预测的概率和实际概率相一致。决策曲线显示本列线图模型在阈值范围为0.1~1.0时具有较好的临床效用。临床影响曲线表明该列线图模型在较宽泛的阈值范围内是可行的,在阈值超过0.4尤为显著。结论利用腹部CT图像特征及临床指标构建了一个列线图模型来预测患者IAH的风险程度,该模型有助于提示IAH及腹腔间室综合征。Objective To analyze and identify CT imaging characteristics and clinical indicators that can predict increased intra-abdominal pressure,in order to establish a reliable nomogram for the prediction of intra-abdominal hypertension(IAH).Methods A retrospective collection was made of patients who were admitted to the ICU of Xuzhou Central Hospital from January 2021 to March 2023 and underwent bladder pressure measurement and abdominal CT scans.A total of 58 patients were included in this study,with 25 patients constituting the IAH group and 33 patients forming the non-IAH group.Clinical indicators and CT imaging features of these patients were collected.Logistic regression was used to perform statistical analysis on these clinical and CT imaging characteristics.The results were then used to construct a nomogram,which was validated and judged for clinical value.Results The study found that the transverse to longitudinal ratio of the abdominal wall(P=0.043;OR=3.102;95%CI:1.034-9.307),the ratio of the abdominal cavity to the abdominal wall longitudinal diameter(P=0.002;OR=12.105;95%CI:2.575-56.897)were independently associated with IAH.The AUC of the nomogram prediction model was 0.925.The calibration curve indicated that the predicted probabilities of the nomogram were consistent with the actual probabilities.Decision curve analysis revealed that the nomogram model had good clinical utility within a threshold range of 0.1 to 1.0.The clinical impact curve suggested that the nomogram model was feasible across a broad range of threshold probabilities,particularly notable when the threshold exceeded 0.4.Conclusion Using the abdominal CT imaging features and clinical indicators,a nomogram model is constructed to predict the risk level of IAH in patients,which is helpful to indicate IAH and abdominal compartment syndrome.

关 键 词：腹腔间室综合征 腹内高压 计算机体层成像 

分 类 号：TP391.41[自动化与计算机技术—计算机应用技术]