基于LASSO-COX回归构建肾结石复发风险护理评估模型

Based on LASSO-COX Regression to Build a Nursing Evaluation Model of Recurrence Risk of Kidney Stones

目的探讨肾结石术后复发影响因素,并构建肾结石复发风险护理评估模型及工具。方法收集我院2016年5月至2018年5月收治的320例肾结石患者临床及随访资料,采用LASSO回归筛选肾结石复发相关影响因素,Kaplan-Meier生存分析评估纳入因素对肾结石复发的影响,建立多因素COX风险回归模型,并采用受试者工作曲线评估模型预测效能。结果经LASSO回归筛选后纳入延续护理、代谢综合征、术后残石、尿液pH为研究因素,Kaplan-Meier生存分析提示参与延续护理、无代谢综合征、无术后残石、尿液pH高的患者肾结石复发中位时间更长,差异有统计学意义(P<0.05),多因素COX回归分析提示延续护理是肾结石复发的独立保护因素[HR=0.048,95%CI(0.014,0.017)],受试者工作曲线下面积为0.962[95%CI(0.902,1.026)],提示模型预测效能较好。结论延续护理是肾结石复发重要保护因素,并初步建立了肾结石术后复发风险护理评估模型。

Objective To explore the influencing factors of recurrence of kidney stones after surgery and build a nursing evaluation model and tools for the risk of kidney stones recurrence.Methods The clinical and follow-up data of 320 patients with kidney stones admitted from May 2016 to May 2018 in our hospital were collected.The LASSO regression was used to screen for the related influencing factors of kidney stone recurrence.A multi-factor COX risk regression model was established and the receiver operating curve to evaluate the model’s predictive effectiveness was used.Results After LASSO regression screening,continuing care,metabolic syndrome,postoperative residual stones,and urine pH were included as research factors.Kaplan-Meier survival analysis suggested that patients who participated in continuing care,no metabolic syndrome,no postoperative residual stones,and high urine pH had a longer median time to relapse of kidney stones,the difference was statistically significant( P < 0.05).Multi-factor COX regression analysis suggests that continued care was an independent protective factor for the recurrence of kidney stones[HR= 0.048,95%CI( 0.014,0.017) ]and the area under the receiver’s working curve is 0.962[95%CI( 0.902,1.026) ].The model predicts better performance.Conclusion Continuing care is an important protective factor for the recurrence of kidney stones,and a nursing evaluation model for the risk of recurrence of kidney stones after surgery is initially established.