急性髓系白血病化疗后口腔黏膜炎风险预测模型的构建

Construction of a risk predictive model for oral mucositis after chemotherapy in acute myeloid leukemia

目的分析急性髓系白血病患者静脉化疗后口腔黏膜炎发生的危险因素,并构建定量风险预测模型指导临床。方法回顾性分析2021年5月~2022年5月我院确诊的急性髓系白血病患者共282例,其中化疗后发生口腔黏膜炎122例。比较黏膜炎组与无黏膜炎组患者的临床资料,多因素Logistic回归分析筛选危险因素,R软件构建列线图模型后采用受试者工作曲线(ROC)和校准曲线进行验证。结果单因素分析显示,两组间年龄、体质指数、原发口腔疾病、口腔卫生、白血病加速期和急变期、化疗疗程、白细胞计数比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、口腔卫生差、急变期和白细胞计数≥20.0×10^(9)/L是口腔黏膜炎发生的独立危险因素(P<0.05)。构建定量列线图模型ROC结果显示,模型预测口腔黏膜炎的曲线下面积(AUC)为0.846(P<0.05)。对模型进行校准后Hosmer-Lemeshow检验显示,拟合优度良好。结论急性髓系白血病患者化疗后口腔黏膜炎的发生风险较高,其中年龄≥60岁、口腔卫生差、急变期和白细胞计数≥20.0×10^(9)/L是口腔黏膜炎发生的独立危险因素,依此建立列线图模型有较好的预测效能及较好的临床应用价值。

Objective To analyze the risk factors of oral mucositis in patients with acute myeloid leukemia after intravenous chemotherapy,and construct a quantitative risk predictive model to guide clinical application.Methods A total of 282 patients with acute myeloid leukemia admitted in our hospital from May 2020 to May 2021 were retrospectively analyzed,including 122 cases of oral mucositis after chemotherapy.The clinical data were compared between mucositis group and non-mucositis group,and the risk factors were screened by multivariate Logistic regression analysis.After R software build the nomogram model,receiver operating curve(ROC)and calibration curve were used for verification.Results Single factor comparison showed that age,body mass index,primary oral diseases,oral hygiene,acceleration phase and acute transformation phase of leukemia,chemotherapy course,and white blood cell count had statistical differences between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years,poor oral hygiene,acute phase and white blood cell count≥20.0×10^(9)/L were independent risk factors for oral mucositis(P<0.05).The area under the curve(AUC)of nomograph model for predicting mucositis was 0.846 by ROC(P<0.05).The Hosmer-lemeshow test showed that the goodness of fit was good after calibration.Conclusion Patients with acute myeloid leukemia have a higher risk of developing oral mucositis after chemotherapy.Among them,age≥60 years,poor oral hygiene,acute phase and white blood cell count≥20.0×10^(9)/L are independent risk factors for oral mucositis.Based on these factors,the nomogram model has good predictive effect and clinical application value.