CT引导下同轴切割肺穿刺活检后肺出血预测模型的建立

Development of a predictive model of pulmonary hemorrhage in patients after CT-guided coaxial core needle lung biopsy

目的基于logistic回归构建CT引导下同轴切割肺穿刺活检后患者肺出血的预测模型。方法回顾性分析489例CT引导下的同轴切割肺穿刺活检,对活检后出血的潜在危险因素进行单因素及多因素logistic回归,筛选术后肺出血的危险因素,建立预测模型,并评价模型的区分度、校准度及临床有效性。结果建模组活检后肺出血141例,占比42.6%,验证组出血66例,占比41.8%,无严重出血及血胸。多因素分析发现血浆纤维蛋白原含量、靶病灶周围肺间质纤维化、靶病灶最大径及穿刺深度是活检后出血的预测因素。建立出血预测模型,以列线图的形式展示。预测模型区分度:建模组AUC为0.837,验证组AUC为0.777。模型的校准曲线表明出血的预测风险与实际风险吻合较好,不可靠性测试建模组P值为0.849,验证组P值为0.147。DCA曲线表明模型可以为患者增加获益。结论基于logistic回归构建的CT引导下同轴切割肺穿刺活检的出血预测模型有较强的临床实用性。

Objective To establish a predictive model for patients with hemorrhage after CT-guided coaxial core needle lung biopsy(CCNB)based on logistic regression.Methods A total of 489 patients who had undergone CCNB were retrospectively recruited.The potential risk factors of hemorrhage after lung biopsy were analyzed by univariate and multivariate logistic regression,through which we screened the independent risk factors and established a prediction model for hemorrhage.We evaluated the discrimination,calibration and clinical usefulness of the model.Results There were 141 cases(42.6%)of hemorrhage in the development group and 66 cases(41.8%)of hemorrhage in the validation group;there was no case of severe hemorrhage or hemothorax.Multivariate logistic regression analysis showed that fibrinogen degradation products,pulmonary interstitial fibrosis,largest diameter and puncture depth were independent predictive factors of hemorrhage.Hemorrhage prediction model was established and presented in the form of a nomogram.Discrimination of the model:the AUC was 0.837 in the development group and 0.777 in the validation group.The calibration curve showed good agreement between predicted probability and actual probability of hemorrhage.The unreliability test yielded a P value of 0.849 in the development group and 0.147 in the validation group.The DCA curve showed that the hemorrhage predictive model could increase the benefit of patients.Conclusion The predictive model of hemorrhage in patients after CCNB based on logistic regression can be used in clinical practice.