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| 构建Nomogram模型预测胃切除术后高级别反流性食管炎的影响因素 |
| Construction of Nomogram model for predicting influencing factors of high grade reflux esophagitis after astrectomy |
| 投稿时间：2024-09-20 |
| DOI：10.3969/j.issn.1000-0399.2025.05.006 |
| 中文关键词: Nomogram预测模型|腹腔镜保留幽门胃切除术|反流性食管炎|影响因素 |
| 英文关键词: Nomogram prediction model|Laparoscopic preserved-pyloric gastrectomy|Reflux esophagitis|Influencing factor |
| 基金项目:张家口市重点研发计划项目(编号:2322062D)~~ |
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| 中文摘要: |
| 目的 构建Nomogram模型预测影响腹腔镜保留幽门胃切除术（LPPG）后高级别反流性食管炎（RE）的危险因素。方法 回顾性分析2013年5月至2023年5月张家口市第一医院1 000例LPPG术后患者临床资料。按照6∶4的比例将患者分为建模组（n=600）和验证组（n=400），根据是否发生高级别RE(B级及以上），将建模组再次分为RE组（n=90）和非RE组（n=510）。对建模组行logistic回归分析影响LPPG术后高级别RE的独立危险因素，采用R语言软件4.0“rms”包构建Nomogram预测模型。采用校准曲线和临床决策曲线对建模组进行Nomogram预测模型内部验证。绘制受试者工作特征曲线，计算曲线下面积（AUC）对建模组和验证组的Nomogram预测模型外部验证，比较两组AUC差异。结果 建模组和验证组临床资料比较，差异无统计学意义（P>0.05）。RE组和非RE组性别、食管裂孔疝、术前A级RE、术后1年身体质量指数（BMI）、长期胃排空障碍差异有统计学意义（P<0.05）。男性、有食管裂孔疝、有术前A级RE、高术后1年BMI、有长期胃排空障碍是影响LPPG术后高级别RE的独立危险因素。内部验证结果显示，Nomo gram模型一致性指数为0.883(95%CI:0.702～0.927），具有良好的一致性，且能够提供高于各独立预测因子的临床净收益。外部验证结果显示，Nomogram模型预测两组高级别RE的AUC差异无统计学意义（P>0.05），且均高于各独立预测因子 。结论 Nomogram模型对LPPG术后高级别RE的预测效能可满足临床要求，具有一定的临床应用和参考价值。 |
| 英文摘要: |
| Objective To construct a Nomogram model and to predict the risk factors affecting high grade reflux esophagitis（RE） after laparoscopic pylorus-preserving gastrectomy（LPPG）. Methods The clinical dataof 1 000 patients after LPPG from May 2013 to May 2023 inZhangjiakou First Hospitalwere retrospectively analyzed. They were divided into a modeling group（n=600） and a validation group（n=400） according to a ratio of 6:4.The modeling group was further divided into an RE group（n=90） and a non RE group（n=510） based on whether high grade RE occurred（grade B and above）. Logistic regression analysis was performed on the modeling group for the independent risk factors affecting high grade RE after LPPG. The Nomogram prediction model was created by using R language software 4.0 “rms” package. The calibration curve and clinical decision curve were used to perform Nomogram prediction model internal validation for the modeling group.Receiver operating characteristic curve was pointed and the area under curve（AUC） was calculated for Nomogram prediction model external validation for the modeling and validation group.The difference in AUC between the two groups was compared. Results The clinical data difference between the modeling group and validation group had no statistical significance（P＞0.05）. There were statistically significant differences in gender, hiatal hernia, preoperative Grade A RE, postoperative one year body mass index（BMI） and long term gastric emptying disorder between the RE group and non RE group（P＜0.05）. Male, hiatal hernia（yes）, preoperative A grade RE（yes）, high postoperative one year BMI and long term gastric emptying disorder（yes） were the independent risk factors affecting high grade RE after LPPG. The internal validation result showed that the consistency index of the Nomogram model was 0.883（95% CI:0.702～0.927）.The model had good consistency and could provide clinical net benefit which was higher than each independent predictor. The external validation result showed that AUC for high grade RE predicted by Nomogram model had no statistically significant difference between the two groups（P＞0.05）. AUC was higher than each independent predictor. Conclusion The predictive performance of the Nomogram model for high grade RE after LPPG can meet clinical requirement and has certain clinical application and reference value. |
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