消化性溃疡合并上消化道出血的危险因素及列线图预测模型的构建  

Risk factors for peptic ulcer combined with upper gastrointestinal bleeding and construction of a nomogram predictive model

作　　者：朱智慧 许飘 李红燕 Zhu Zhihui;Xu Piao;Li Hongyan(Second Ward,Living Water Hospital,Digestive Diagnostic and Treatment Center,Jiu Jiang NO.1 People’s Hospital,Jiujiang,Jiangxi 332600,China)

机构地区：[1]九江市第一人民医院消化诊疗中心活水院二病区,江西九江332600

出　　处：《齐齐哈尔医学院学报》2025年第4期359-363,共5页Journal of Qiqihar Medical University

摘　　要：目的 分析消化性溃疡合并上消化道出血的危险因素,并构建列线图预测模型。方法 选择2022年6月—2024年3月本院收治的消化性溃疡患者100例作为研究对象,根据有无上消化道出血分为非出血组(64例)和出血组(36例)两组。观察两组患者的临床资料;采用MedCalc软件进行ROC曲线分析,采用Logistic分析其独立危险因素;采用R语言软件构建Nomogram预测模型(列线图预测模型),采用校正曲线对Nomogram预测模型进行内部验证,计算一致性指数(Concordanceindex, C-index)、决策曲线对Nomogram预测模型进行临床预测效能评估。结果 两组患者在年龄、性别、是否吸烟、肝脏疾病、BMI等一般资料的比较中,差异无统计学意义(P>0.05);与上消化道无出血患者相比,出血组患者SAS评分、PG1和PG2水平都较高(P>0.05),对消化性溃疡伴上消化道出血有一定预测价值,AUC分别为0.849,0.788,0.787(P<0.05)。饮酒情况、SAS评分、是否使用非甾体抗炎药、是否使用抗血小板药、是否感染幽门螺旋杆菌、PG1和PG2是消化性溃疡伴上消化道出血的影响因素(P<0.05)。Nomogram模型在预测消化性溃疡伴上消化道出血风险方面表现良好,其C-index为0.984 (0.966~1.001);当其风险阈值>0.06时,该模型可以较好地提供标准化净收益。结论 饮酒情况、SAS评分、是否使用非甾体抗炎药、PG1和PG2水平是患者上消化道出血的影响因素,且模型有较好的预测能力。Objective To analyze the risk factors of peptic ulcer combined with upper gastrointestinal bleeding and to construct a predictive model for the nomogram.Methods A total of 100 patients with peptic ulcer admitted to our hospital from June 2022 to March 2024 were selected as study subjects and divided into two groups based on the presence or absence of upper gastrointestinal bleeding.The non-bleeding group consisted of 64 cases of peptic ulcer without upper gastrointestinal bleeding,and the bleeding group consisted of 36 cases with upper gastrointestinal bleeding.Clinical data of the patients in both groups were observed;MedCalc software was used to analyze the ROC curve,and logistic analysis was used to identify independent risk factors;R language software was used to construct the Nomogram predictive model(line drawing predictive model),and the calibration curve was used to internally validate the Nomogram predictive model,calculating the concordance index(C-index),and the clinical predictive efficacy of the Nomogram predictive model was evaluated using decision curves.Results There were no statistically significant differences between the two groups in general information such as age,gender,smoking status,liver disease,BMI,etc.(P>0.05);compared with patients without upper gastrointestinal bleeding,the bleeding group had higher SAS scores and higher levels of PG1 and PG2(P>0.05),which had certain predictive value for peptic ulcer with upper gastrointestinal bleeding,with AUCs of 0.849,0.788,and 0.787(P<0.05).Alcohol consumption,SAS score,use of non-steroidal anti-inflammatory drugs,use of antiplatelet agents,infection with Helicobacter pylori,PG1,PG2 were influencing factors of peptic ulcer with upper gastrointestinal bleeding(P<0.05).The Nomogram model performed well in predicting the risk of peptic ulcer with upper gastrointestinal bleeding,with a C-index of 0.984(0.966~1.001);the model provides better standardized net benefit when its risk threshold is>0.06.Conclusions Alcohol consumption,SAS score,use of non-

关 键 词：消化性溃疡 上消化道出血 危险因素 Nomogram预测模型 

分 类 号：R573.1[医药卫生—消化系统] R573.2[医药卫生—内科学]