良性输尿管狭窄球囊扩张术的复发风险分析及列线图构建

Construction of a nomogram to predict recurrence risk in patients with ureteral stenosis following balloon dilatation

目的构建预测输尿管狭窄球囊扩张术后输尿管狭窄复发风险的临床列线图。方法回顾性分析同济大学附属第十人民医院2018年8月—2021年7月因输尿管镜碎石术后输尿管狭窄行输尿管球囊扩张的80例患者。收集患者的临床及术后随访资料,按照输尿管狭窄的复发分为复发组和无复发组,经由LASSO回归及单因素分析筛选变量,并进行多因素Logistic回归,构建列线图,采用C指数评估列线图的辨识度,采用十折交叉验证及Bootstrap验证进行内部验证,并用ROC曲线下面积(AUC)评估内部验证结果。结果本研究共纳入患者80例,随访时间642个月,平均(21.1±10.5)个月,输尿管狭窄复发患者20例。临床手术成功率75%。4个重要的预测因素:长狭窄段(长度≥10 mm)(P=0.002)、血供受损(P=0.036)、病程≥1年(P=0.012)、严重输尿管狭窄(针孔样)(P=0.039)被纳入列线图模型。该模型的C指数为0.882(95%CI:0.8060.958)。内部验证表明,十折交叉验证迭代200次后计算所得的平均AUC为0.837。结论狭窄段长度、血供受损、病程及狭窄程度是输尿管狭窄球囊扩张术后复发的独立危险因素,基于上述四项因素构建了一个可以有效预测输尿管狭窄球囊扩张术后输尿管狭窄复发的列线图,这有助于确定输尿管狭窄的最佳球囊扩张患者并改善治疗效果,但是还有必要对列线图进行进一步的外部验证。

Objective To construct a nomogram for predicting the recurrence risk of ureteral stricture after balloon dilatation.Methods Clinical data of 80 patients who underwent ureteral balloon dilatation due to ureteral stricture after endoscopic lithotripsy from August 2018 to July 2021 were analyzed retrospectively.The risk factors of recurrence of ureteral stricture were screened by LASSO regression and univariate analysis,and analyzed by multivariate Logistic regression.A prediction nomogram model was constructed based on the identified risk factors.The performance of the nomogram was evaluated by C index,the internal validation was carried out by 10 fold cross validation and bootstrap validation;and the internal validation results were evaluated by area under the ROC curve(AUC).Results Patients were followed up for 642 months(21.1±10.5 months),and the recurrent ureteral stricture occurred in 20 cases.Multivariate regression showed that the long stenosis(length≥10 mm)(P=0.002),impaired blood supply(P=0.036),course≥1 year(P=0.012),and severe ureteral stenosis(pinhole like)(P=0.039)were independent risk factors for recurrent ureteral stricture,based on which a nomogram model was constructed.The C index of the model was 0.882(95%CI:0.8060.958).Internal validation shows that the average AUC calculated after 200 iterations of 10 fold cross validation was 0.837.Conclusion The length of stricture,impacted blood supply,course of disease and degree of stricture are independent risk factors for the recurrence of ureteral stricture after balloon dilatation.Based on the above four factors,we constructed a nomogram that can effectively predict the recurrence of ureteral stricture after balloon dilatation.However,further external verification of the nomogram is necessary.