老年肺癌患者行电磁导航支气管镜活检术后活检部位出血风险因素预测模型的建立与验证

Establishment and Validation of a Predictive Model for Risk Factors of Biopsy Site Bleeding in Elderly Lung Cancer Patients Undergoing Electromagnetic Navigation Bronchoscopy Biopsy

目的建立与验证老年肺癌患者行电磁导航支气管镜活检术后活检部位出血风险因素预测模型。方法选择南京医科大学第一附属医院2020年1月~2023年1月收治的80例行电磁导航支气管镜活检术的老年肺癌患者作为观察组,另外选择同期行电磁导航支气管镜活检的50例老年肺癌患者作为模型验证组。采用Spearman相关性检验分析各指标与出血的关系,利用logistic回归模型构建电磁导航支气管镜活检术后活检部位出血风险因素的预测模型,以患者术后痰中带血作为活检部位出血的金标准绘制ROC曲线,验证该模型的临床应用价值。结果观察组术后活检部位出血者31例,未出血者49例,出血组和未出血组年龄、病灶位置、术中出血量、病灶直径比较,差异均有统计学意义(P<0.05);年龄、病灶位置、术中出血量、病灶直径与术后活检部位出血呈正相关(P<0.05);构建的预测模型为Log(P)=0.754×年龄+0.638×病灶位置+0.671×术中出血量+0.701×病灶直径;验证组数据检验模型的ROC曲线下面积为0.871(95%CI:0.782~0.960,P<0.001),风险预测模型的准确率为88.00%。结论基于年龄、病灶位置、术中出血量、病灶直径构建的电磁导航支气管镜活检术后活检部位出血风险预测模型具有较高的预测价值。

Objective To establish and validate a predictive model for risk factors of biopsy site bleeding after electromagnetic navigation bronchoscopic biopsy in elderly patients with lung cancer.Methods 80 elderly patients with lung cancer who underwent electromagnetic navigation bronchoscopic biopsy from January 2020 to January 2023 in The First Affiliated Hospital with Nanjing Medical University were selected as the observation group,and 50 elderly patients with lung cancer who underwent electromagnetic navigation bronchoscopic biopsy were selected as the model validation group at the same time.Spearman correlation test was used to analyze the relationship between each index and bleeding,logistic regression model was used to construct a prediction model of risk factors for bleeding at the biopsy site after electromagnetic navigation bronchoscopic biopsy,and ROC curve was drawn using blood in the sputum of patients after surgery as the gold standard for bleeding at the biopsy site to verify the clinical application value of this model.Results In the observation group,there were 31 cases of postoperative biopsy site bleeding and 49 cases of non-bleeding.There were significant differences in age,lesion location,intraoperative blood loss and lesion diameter between the bleeding group and the non-bleeding group(P0.05);there was a significant positive correlation between age,lesion location,intraoperative blood loss and lesion diameter and postoperative biopsy site bleeding(P0.05);the constructed prediction model was Log(P)=0.754×age+0.638×lesion location+0.671×intraoperative blood loss+0.701×lesion diameter;the area under ROC curve of the verification group data test model was 0.871(95%CI:0.782~0.960,P0.001),and the accuracy of the risk prediction model was 88.00%.Conclusion The predictive model of biopsy site bleeding risk after electromagnetic navigation bronchoscopic biopsy based on age,lesion location,intraoperative blood loss and lesion diameter has a high predictive value.