多发性骨髓瘤病人椎体压缩性骨折风险预测模型构建分析

Construction and analysis of risk prediction model for vertebral compression fractures in patients with multiple myeloma

目的构建多发性骨髓瘤(MM)病人椎体压缩性骨折风险预测模型。方法选取2017年4月~2021年1月我院收治的MM病人114例,根据病人是否发生椎体压缩性骨折为骨折组和未骨折组,通过Logistic多因素分析探求MM病人椎体压缩性骨折风险的影响因素,并构建列线图预测模型,通过C-index指数和校正曲线检验模型预测效能。结果截止2021年5月1日,44例发生椎体压缩性骨折,70例未发生椎体压缩性骨折,椎体压缩性骨折发生率为38.60%;骨折组与未骨折组体重指数、HU值、骨髓浆细胞比例、脊柱肿瘤脊椎不稳评分(SINS)比较差异有统计学意义(P<0.05);多因素Logistic分析显示,高体重指数(OR=0.464,95%CI 0.293~0.735)、高HU值(OR=0.966,95%CI 0.949~0.984)为骨折的保护因素,高SINS(OR=1.285,95%CI 1.111~1.487)、骨髓浆细胞比例大(OR=1.078,95%CI 1.025~1.133)为骨折的危险因素(P<0.05);基于上述因素的骨折风险预测模型预测一致性指数(C-index)为0.913(95%CI 0.863~0.963),校正曲线显示观察与实际预测情况一致性好。结论由体重指数、HU值、骨髓浆细胞比例、SINS因素构建的MM病人椎体压缩性骨折风险模型具有较高的预测价值。

Objective To explore the construction of a risk prediction model for vertebral compression fractures in patients with multiple myeloma(MM).Method Prospectively selected 114 patients with MM admitted to Tangshan People’s Hospital from April 2017 to January 2021 as the research objects.According to whether the patients had vertebral compression fractures,they were divided into the fracture group and the non-fracture group.Multi-factor analysis was used to explore the influencing factors of the risk of vertebral compression fractures in MM patients,and the nomogram prediction model was constructed,and the prediction performance of the model was tested through the C-index index and the calibration curve.Result As of May 1,2021,44 cases had vertebral compression fractures,70 cases had no vertebral compression fractures,and the incidence of vertebral compression fractures was 38.60%.There were statistically significant differences in body mass index,HU value,bone marrow plasma cell ratio,and spinal tumor spinal instability score(SINS)between the fracture group and the unfractured group(P<0.05).Multivariate logistic analysis showed that body mass index(OR=0.464,95%CI 0.293~0.735)and HU value(OR=0.966,95%CI 0.949~0.984)were protective factors for fractures,SINS(OR=1.285,95%CI 1.111~1.487),bone marrow plasma cell ratio(OR=1.078,95%CI 1.025~1.133)are risk factors for fracture(all P<0.05).The fracture risk prediction model based on the above factors predicts the consistency index(C-index)is 0.913(95%CI 0.863~0.963),and the calibration curve shows that the observation is in good agreement with the actual prediction.Conclusion The risk model of vertebral compression fracture in MM patients constructed by body mass index,HU value,bone marrow plasma cell ratio and SINS factors has high predictive value.