慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后复发的危险因素及相关模型构建

Risk factors for recurrence of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery and construction of related prediction model

目的探讨慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后复发的影响因素并构建相关模型。方法选择2017年1—12月行鼻内镜术的172例慢性鼻-鼻窦炎伴鼻息肉患者作为研究对象,以患者术后1年内是否复发作为分组依据,将复发的48例患者纳入复发组,将未复发的124例患者纳入未复发组,对两组患者的临床资料进行单因素和多因素Logistic回归分析,并建立预测模型,应用工作特征(ROC)曲线检测其区分度,应用拟合优度检验评价其校准度。选取2019年1—7月行鼻内镜术的80例慢性鼻-鼻窦炎伴鼻息肉患者进行预测模型的临床验证。结果单因素结果表明:两组患者的年龄、鼻窦炎分型、哮喘、手术时间、焦虑自评量表(SAS)评分相比较,差异均具有统计学意义(P均<0.05);多因素Logistic回归分析结果显示:年龄、鼻窦炎分型、哮喘、手术时间、SAS评分与术后复发均有相关性(P均<0.05);患者行鼻内镜术后复发的概率预测模型的曲线下面积(AUC)为0.936。该模型的临床验证显示灵敏度为85.00%,特异度为93.33%,预测正确率为91.25%。结论年龄、鼻窦炎分型、哮喘、手术时间、SAS评分是慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后复发的影响因素。根据各危险因素的构建模型能够有效预测患者术后复发概率。

Objective To investigate the factors influencing the recurrence of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery and construct related prediction model.Methods One hundred seventy-two patients suffering from chronic rhinosinusitis with nasal polyps surgically treated under endoscope in our department from Jan 2017 to Dec 2017 were selected as the research objects.Based on whether the chronic rhinosinusitis with nasal polyps recurred within 1 year after surgery,48 patients with recurrence were included in the recurrent group,and 124 patients without recurrence in the nonrecurrent group.Single-factor and multi-factor logistic regression analyses were performed on the clinical data of both groups,and the prediction model was established.The receiver operation characteristic(ROC)curve was used to detect its discrimination,and the goodness of fit test was used to evaluate its calibration.Eighty patients suffering from chronic rhinosinusitis with nasal polyps surgically treated under endoscope in our department from Jan 2019 to July 2019 were selected for clinical verification of the prediction model.Results The single-factor analysis showed that the differences in patients’age,sinusitis type,asthma,operation time,and self-rating anxiety scale(SAS)score between the two groups were all statistically significant(all P<0.05).Multivariate logistic regression analysis indicated that patients’age,sinusitis type,asthma,operation time,SAS score were correlated with postoperative recurrence(all P<0.05).The probability prediction model of recurrence after endoscopic sinus surgery of the area under the curve(AUC)of the model was 0.936.The clinical validation of the model showed that the sensitivity was 85.00%and the specificity was 93.33%with the prediction accuracy of 91.25%.Conclusions Patients’age,type of sinusitis,asthma,operation time,and SAS score are the influencing factors for the recurrence of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery.The model constructed on various risk factors can effectively predict the probability of recurrence after surgery.