老年患者内镜下胃肠道息肉切除术后腹部急性疼痛风险预测模型构建及验证  

Construction and verification of risk prediction model for acute abdominal pain after endoscopic gastrointestinal polypectomy in elderly patients

作　　者：张慧月 钟艺馨 尧馨 何子妍 ZHANG Huiyue;ZHONG Yixin;YAO Xin;HE Ziyan(Department of Gastroenterology,the 2nd Affiliated Hospital of Chengdu Medical College-Nuclear Industry 416 Hospital,Chengdu 610051,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院消化内科,四川成都610051

出　　处：《陕西医学杂志》2025年第5期659-664,668,共7页Shaanxi Medical Journal

基　　金：四川省科技创新苗子工程资助项目(MZGC20230028)。

摘　　要：目的:探讨老年患者内镜下胃肠道息肉切除术后发生腹部急性疼痛的影响因素,并构建风险预测模型及验证。方法:选取行内镜下胃肠道息肉切除术的老年患者252例,分为建模组(202例)和验证组(50例)。根据建模组患者术后24 h内是否发生腹部急性疼痛,分为疼痛组(41例)和非疼痛组(161例)。采用二元Logistic回归分析老年患者内镜下胃肠道息肉切除术后发生腹部急性疼痛的影响因素并建立风险预测模型,并通过绘制受试者工作特征(ROC)曲线、校准曲线、决策曲线分析(DCA)评估模型预测效能。结果:建模组和验证组临床资料比较差异无统计学意义(均P>0.05)。与非疼痛组比较,疼痛组患者年龄、切除息肉直径增大,SAS评分、SDS评分、入院当天VAS评分升高,术前慢性疼痛、术前疼痛急性加重、切除息肉数量>2个比例增加,手术时间延长(均P<0.05)。年龄、SAS评分、入院当天VAS评分以及切除息肉直径为老年患者内镜下胃肠道息肉切除术后腹部急性疼痛的独立影响因素(均P<0.05)。根据二元Logistic回归分析结果构建老年患者内镜下胃肠道息肉切除术后发生腹部急性疼痛的风险预测列线图模型。绘制ROC曲线分析列线图模型预测建模组发生腹部急性疼痛的曲线下面积(AUC)为0.929,验证组AUC为0.920(均P<0.05)。校准曲线分析显示校准曲线与理想曲线拟合良好。DCA曲线分析阈概率值各范围净收益均大于0。结论:年龄、SAS评分、入院当天VAS评分、息肉直径是老年患者内镜下胃肠道息肉切除术后发生腹部急性疼痛的独立影响因素,以此构建的风险预测模型预测效能较好。Objective:To investigate the influencing factors of acute abdominal pain after endoscopic gastrointestinal polypectomy in elderly patients and to construct a risk prediction model and verify it.Methods:A total of 252 elderly patients who underwent endoscopic gastrointestinal polypectomy were selected and divided into a modeling group(202 cases)and a validation group(50 cases).Based on whether acute abdominal pain occurred within 24 hours after surgery in the modeling group,the patients were further divided into a pain group(41 cases)and a non-pain group(161 cases).Binary logistic regression analysis was used to identify the influencing factors of acute abdominal pain after endoscopic gastrointestinal polypectomy in elderly patients and to establish a risk prediction model.The model’s predictive performance was assessed using receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DCA).Results:There were no significant differences in clinical data between the modeling group and the validation group(all P>0.05).Compared with the non-pain group,the pain group had higher age,larger diameter of resected polyps,higher SAS and SDS scores,higher VAS score on the day of admission,and increased proportions of preoperative chronic pain,preoperative acute exacerbation of pain,and more than two polyps removed(all P<0.05).Additionally,the pain group had longer surgical duration(P<0.05).Age,SAS score,VAS score on the day of admission and diameter of resected polyps were identified as independent influencing factors for acute abdominal pain after endoscopic gastrointestinal polypectomy in elderly patients(all P<0.05).Based on the results of binary logistic regression analysis,a nomogram model for predicting acute abdominal pain after endoscopic gastrointestinal polypectomy in elderly patients was constructed.The ROC curve analysis showed that the area under the curve(AUC)of the nomogram model for predicting acute abdominal pain in the modeling group was 0.929,and in the validation group was

关 键 词：胃肠道息肉 老年 内镜下息肉切除术 腹部急性疼痛 影响因素 预测模型 

分 类 号：R57[医药卫生—消化系统]