成年女性压力性尿失禁风险预测模型的构建及验证

Construction and validation of risk prediction model for stress urinary incontinence in adult women

目的分析成年女性发生压力性尿失禁的相关影响因素,构建个体化成年女性压力性尿失禁风险预测模型,为成年女性压力性尿失禁(SUI)高风险人群提供筛查工具。方法回顾性收集2019年10月至2021年10月宁夏医科大学总医院妇科盆底诊治中心就诊的成年女性,分别在确诊SUI的患者及查体健康的成年女性中随机选取400例。依据纳入、排除标准分为SUI组(169例)和非SUI组(231例),分别通过单因素、多因素logistic逐步回归分析,筛选成年女性压力性尿失禁相关危险因素,构建成年女性压力性尿失禁风险预测模型并绘制列线图。绘制受试者工作特征曲线(ROC)并计算曲线下面积AUC、校准曲线及DCA曲线分别评估预测模型的区分度、一致性及临床有用性,综合评估该模型的预测效能。采用Bootstrap重抽样法(500次)进行模型内部验证。结果年龄,BMI,绝经,经阴道分娩史,合并非肿瘤妇科疾病史是成年女性发生SUI的相对危险因素(P<0.05)。本研究建立的成年女性压力性尿失禁风险预测模型的区分度较好(AUC=0.8854,95%CI,0.854~0.9168);校准曲线是斜率接近为1的虚线;绘制决策曲线分析法(DCA)得出临床有用性阈值为0.4;内部验证显示验证后的ROC曲线下面积AUC约为0.8767,灵敏度81%,特异度70%。结论年龄,BMI,绝经,阴道分娩史、合并非肿瘤妇科疾病是成年女性SUI相关危险因素,本研究通过纳入危险因素构建预测成年女性发生压力性尿失禁的风险预测模型经过内部验证及模型评价表现良好。

Objective To analyze the relevant influencing factors of stress urinary incontinence(SUI)in adult women,and construct an individualized risk prediction model for SUI in adult women,so as to provide a SUI screening tool for high-risk adult women.Methods 400 adult women were retrospectively collected as the research subjects.According to the inclusion and exclusion criteria,they were divided into SUI group(169 cases)and non-SUI group(231 cases).A multivariate logistic stepwise regression analysis was performed to screen the independent risk factors related to stress urinary incontinence in adult women and a multivariate logistic stepwise regression model was established.The risk prediction model of stress urinary incontinence for adult female was constructed and the nomograms were drawn,and the web-based dynamic nomograms were developed.The area AUC under the receiver operating characteristic curve(ROC),the calibration curve,and the DCA curve were used to evaluate the discrimination,consistency and clinical usefulness of the prediction model,respectively.The prediction efficiency of the model was comprehensively evaluated.The Bootstrap resampling method(500 resampling times)was used for internal verification of the stress urinary incontinence risk prediction model for adult female.Results Age,BMI,menopause,history of vaginal delivery and history of non-neoplastic gynecological diseases were the relatively independent risk factors for SUI in adult women(P<0.05).The risk prediction models for stress urinary incontinence established in this study had a good discrimination(AUC=0.8854,95%CI,0.854~0.9168).The calibration curve was a dashed line with a slope close to 1.The threshold value was 0.4.The internal validation showed that the AUC under the ROC curve after validation was approximately 0.8767,with a sensitivity of 81%and a specificity of 70%.Conclusion Age,BMI,menopause,history of vaginal delivery and combined with non-tumor gynecological diseases are the related risk factors for adult women with SUI.The risk prediction model for predicting the occurrence of stress urinary incontinence in adult women is constructed by incorporating risk factors.After internal verification and model evaluation,the model performes well,and it may provide a scientific screening tool for adult women.