手术切除手足关节痛风石患者康复情况影响因素分析及临床预测模型

Analysis of Influencing Factors and Clinical Prediction Model of Rehabilitation in Patients Undergoing Surgical Resection of Hand-foot Joint Tophi

目的 分析影响手术切除手足关节痛风石患者康复情况的危险因素,并构建临床预测模型。方法 选取2017年1月至2021年6月我院收治的手术切除手足关节痛风石的病例105例,根据患者术后4个月康复情况分为显效组65例和非显效组40例,记录患者性别、年龄、病程、高血压病、糖尿病、高脂血症、术后饮酒、手术方式、医嘱依从性、术后清淡饮食、术前痛风发作情况、术后心理状态、术后功能锻炼等因素,对相关因子进行单因素分析,并对有统计学意义的因子再进行多因素logistic回归分析,并建立风险预测模型。随后使用该模型对剩下的40例患者进行评估,结果采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)进行统计分析,检验该临床预测模型的预测效能。结果 两组在年龄、术后饮酒、手术方式、医嘱依从性、术后清淡饮食、术后心理状态这6项危险因素上比较,差异有统计学意义(P<0.05)。对这些因素使用logistic回归分析构建临床预测模型。通过ROC曲线评价该模型的鉴别效度,结果显示:AUC=0.867,敏感度为81.3%,特异度为83.3%。结论 手术切除手足关节痛风石患者康复情况受多种因素影响,以此建立的临床预测模型对手术切除手足关节痛风石患者康复情况预测具有良好的判别能力,值得临床应用与进一步研究。

Objectives To analyze the risk factors affecting the rehabilitation of patients with surgical removal of hand-foot joint tophi,and to construct a clinical prediction model.Methods A total of 105 patients with hand-foot joint tophiundergoing surgical removalin our hospital from January 2017 to June 2021 were selected,and they were divided into markedly effective group and non-markedly effective group based on the recovery condition of patients4 months after surgery,with 65 cases and 40 cases,respectively.Factors such as patients’gender,age,course of disease,hypertension,diabetes,hyperlipidemia,postoperative drinking, surgical methods,and compliance to doctors' orders,postoperative light diet,preoperative gout attack, postoperative psychological state and postoperative functional exercise were recorded.Univariate analysis was performed on the related factors,multivariate logistic regression analysis was performed on the statistically significant factors, and a risk prediction model was established. Then, the model was used to evaluate the remaining 40 patients. The results were statistically analyzed using the area under curve(AUC) of receiver operating characteristic(ROC) to test the prediction efficiency of the clinical prediction model.Results There were statistically significant differences between the two groups in age, postoperative drinking, surgicalmethod,compliance to the doctors,postoperative light diet and postoperative psychological state(P<0.05). Logistic regression analysis was used to construct the clinical prediction modelfor these factors.The discriminate validity of the model was evaluated by ROC curve.The results showed that AUC=0.867,sensitivity was 81.3%, and the specificity was 83.3%.Conclusions The rehabilitation of patients with surgical resection of hand-foot joint tophi is affected by many factors,and the clinical prediction model established on thus basis has a good discriminant ability for the prediction of rehabilitation of patients with surgical resection of hand-foot joint tophi, which is worthy of clinical application and further research.