老年结肠镜检查患者肠道准备失败风险评分模型的构建及验证

Development and validation of a risk score model for inadequate bowel preparation for colonoscopy in elderly patients

目的分析老年结肠镜检查患者肠道准备失败的危险因素,并构建风险评分模型,为制订针对性的干预措施提供依据。方法采用便利抽样法,选取2021年5月—10月在太原市某三级甲等医院进行结肠镜检查的610例老年患者作为调查对象,采用随机数字表法分为建模组(406例)和验证组(204例)。依据肠道准备质量,将建模组患者分为肠道准备成功组和失败组,采用Logistic回归分析确定肠道准备失败的独立危险因素,并构建风险评分模型。采用Hosmer-Lemeshowχ2检验及受试者操作特征曲线下面积评价模型的预测效果。结果Logistic回归分析结果显示,年龄>65岁、BMI≥24、合并便秘、合并糖尿病、有结直肠手术史、首次进行结肠镜检查是老年患者肠道准备失败的独立危险因素,相应的风险评分依次为2、2、3、2、5、4分,评分≥8分为高风险人群。建模组检验结果显示,Hosmer-Lemeshow χ^(2)=8.969,P=0.255;受试者操作特征曲线下面积为0.717(P<0.001),灵敏度为50.89%,特异度为79.59%。验证组检验结果显示,Hosmer-Lemeshow χ^(2)=4.188,P=0.840;受试者操作特征曲线下面积为0.720(P<0.001),灵敏度为48.38%,特异度为81.69%,正确率为71.57%。结论该研究构建的风险评分模型的预测效果良好,可为临床医护人员评估老年结肠镜检查患者肠道准备失败的风险提供参考。

Objective To analyze the influencing factors of inadequate bowel preparation in elderly patients undergoing colonoscopy,to construct a risk score model,and to provide the evidence for targeted intervention measures.Methods A total of 610 elderly patients undergoing colonoscopy in a tertiary A hospital in Taiyuan from May 2021 to October 2021 were enrolled by convenience sampling method,and they were divided into a development group(406 cases)and a validation group(204 cases)by random number table method.The patients in the development group were divided into a successful group and a failed group according to the quality of bowel preparation.Then the Logistic regression analysis was used to analyze the risk factors and construct risk score model.Hosmer-Lemeshow χ^(2) test and the area under the ROC curve were used to evaluate the predictive effect of the model.Results Logistic regression analysis showed that age>65 years,BMI≥24,constipation,diabetes,history of colorectal surgery,and the first experience of colonoscopy were independent risk factors for inadequate bowel preparation in elderly patients,and the corresponding risk score were 2,2,3,2,5,4 points,respectively(high-risk group included patients scored≥8 points).In the development group,the results showed that Hosmer-Lemeshow χ^(2)=8.969,P=0.255;the area under ROC curve was 0.717(P<0.001),with the sensitivity and specificity of 50.89% and 79.59%.In the validation group,the results showed that Hosmer-Lemeshow χ^(2)=4.188,P=0.840;the area under the ROC curve was 0.720(P<0.001),with the sensitivity and the specificity of 48.38% and 81.69%,and the accuracy was 71.57%.Conclusion The risk score model constructed in this study has good predictive effects and it can provide the reference for clinical assessment of inadequate bowel preparation risk in elderly patients undergoing colonoscopy.