食管癌患者术后多重耐药菌感染预测模型的构建与效果评价  

Construction and effect evaluation of multi-drug resistant bacterial infection prediction model for patients with esophageal cancer after operation

作　　者：卜静[1] 王芃堉 杨兴肖[1] BU Jing;WANG Pengyu;YANG Xingxiao(Department of Infection Management,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Clinical Laboratory,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院感染管理科,050011 [2]河北医科大学第四医院检验科,050011

出　　处：《天津医药》2025年第3期242-246,共5页Tianjin Medical Journal

基　　金：国家自然科学基金青年项目(81903118);河北省自然科学基金资助项目(H2020206292);河北省医学科学研究课题计划(20250101)。

摘　　要：目的分析食管癌患者术后并发多重耐药菌(MDRO)感染的危险因素,构建列线图模型并评价模型预测拟合效果,以辅助医生做出准确的临床决策。方法选取接受手术治疗的食管癌患者116例,依据是否MDRO感染分为感染组(25例)和未感染组(91例),比较2组的入院时美国麻醉医师协会(ASA)评分,肿瘤位置(上段、中段、下段),手术方式(腔镜、开腹),临床分期,放化疗史,术前营养状态,入院时白细胞计数,引流管保留时间,中心静脉导管留置时间,ICU住院时间,总住院时间。采用主成分分析(PCA)对数据进行筛选和降维。多因素Logistic回归分析患者术后发生MDRO感染的危险因素。构建MDRO感染风险的列线图模型,并通过受试者工作特征(ROC)曲线和校准曲线评价模型的预测拟合效果。结果与未感染组相比,感染组患者ASA评分(≥3分)、开腹手术、临床分期Ⅲ期、术前营养状态差患者比例较高,引流管保留时间、中心静脉导管留置时间和ICU住院时间长(P<0.05)。多因素Logistic回归分析提示开腹手术、ICU住院时间较长、术前营养状态差是食管癌患者术后并发MDRO感染的危险因素(P<0.05),基于此构建的列线图模型ROC曲线下面积为0.828(0.759~0.897),Hosmer-Lemeshow检验结果示模型拟合优度较好(χ^(2)=0.426,P=1.000),模型有较高的校准度及临床使用度。结论基于手术方式、ICU住院时间和术前营养状态构建的列线图风险预测模型具有良好的预测能力。Objective To analyze the risk factors of postoperative multi-drug resistant bacteria(MDRO)infection in patients with esophageal cancer,construct the nomogram model and evaluate fitting effect of the model,so as to help doctors make accurate clinical decisions.Methods A total of 116 patients with esophageal cancer who received surgical treatment were selected and divided into the infected group(25 cases)and the uninfected group(91 cases)according to whether they were infected with MDRO.American anesthesia association of physicians rating(ASA)score and tumor locations(upper,middle and lower segments)on admission were compared between the two groups.Surgical method(endoscopic,open),clinical stage,history of chemoradiotherapy,preoperative nutritional status,white blood cell count at admission,retention time of drainage tube,retention time of central venous catheter,length of ICU stay and total length of hospital stay were also compared between the two groups.Principal component analysis(PCA)was used to screen and reduce the dimension of the data.Multivariate Logistic regression analysis was performed to analyze the risk factors of postoperative MDRO infection.A nomogram model of MDRO infection risk was constructed,and the predictive fitting effect of the model was evaluated by receiver operating characteristic(ROC)curve and calibration curve.Results Compared with the uninfected group,higher ASA score(≥3 points),laparotomy and clinical stage Ⅲ,higher proportion of patients with poor nutritional status before surgery,longer drainage tube retention time,central venous catheter retention time and long ICU stay time were found in the infected group(P<0.05).Multivariate Logistic regression analysis suggested that open surgery,long stay in ICU and poor preoperative nutritional status were risk factors for postoperative MDRO infection in patients with esophageal cancer(P<0.05).Based on this,the area under ROC curve of the nomogram model was 0.828(0.759-0.897).The results of Hosmer-Lemeshow test showed χ^(2)=0.426,P=1.00

关 键 词：食管肿瘤 剖腹术 列线图 危险因素 住院时间 多重耐药菌 

分 类 号：R735.1[医药卫生—肿瘤] R63[医药卫生—临床医学]