经会阴前列腺穿刺活检术疼痛风险评估模型的构建

Construction of a pain risk assessment model for transperineal prostate aspiration biopsy

目的分析经会阴前列腺穿刺活检术疼痛的影响因素,构建列线图模型并验证。方法回顾性收集2021年9月—2023年5月在连云港市第一人民医院行经会阴前列腺活检术420例患者,调查患者的一般资料、入院合并症、实验室指标、焦虑评分和疼痛发生情况。分析经会阴活检术患者发生中重度疼痛的影响因素,建立列线图模型并进行验证。结果Logistic回归分析显示年龄、前列腺体积、焦虑、糖尿病、活检时间和针数是发生中重度疼痛的影响因素。据此建立的列线图模型建模组和验证组的曲线下面积(Area under the curve,AUC)分别为0.894[95%CI(0.857,0.931)]和0.879[95%CI(0.813,0.945)]。建模组和验证组的校正曲线显示预测概率和实际概率具有较好的一致性,决策曲线(Decision-curve analysis DCA)临床净收益较为理想。结论患者年龄、前列腺体积、焦虑、糖尿病、活检时间和活检针数是经会阴前列腺活检术中发生中重度疼痛的影响因素,基于此构建的列线图风险评估模型具有良好预测性和一致性,可为临床工作者判断经会阴前列腺活检患者发生中重度疼痛的风险提供依据。

Objective To analyze the influencing factors of transperineal prostate puncture biopsy pain,and construct a column⁃line diagram model and validate it.Methods Clinical data of 420 patients who underwent transperineal prostate biopsy in the First People’s Hospital of Lianyungang City from September 2021 to May 2023 were retrospectively analyzed,including general information,admission comorbidities,laboratory indexes,anxiety scores,and the occurrence of pain of the patients.Factors affecting the occurrence of moderate⁃to⁃severe pain in patients undergoing transperineal biopsy were analyzed,and a column⁃line graph model was established and validated.Results Logistic regression analysis showed that age,prostate volume,anxiety,diabetes mellitus,biopsy time and number of needles were influencing factors for the occurrence of moderate to severe pain.The area under the curve(AUC)of the modeling and validation groups was 0.894[95%CI(0.857,0.931)]and 0.879[95%CI(0.813,0.945)],respectively.The calibration curves for the modeling and validation groups exhibited good consistency between the predicted probability and the actual probability,DCA curves had more favorable clinical net returns.Conclusion Patient age,prostate volume,anxiety score,diabetes mellitus,biopsy time,and number of biopsy needles are the influencing factors for the occurrence of moderate⁃to⁃severe pain during transperineal prostate biopsy,and a column⁃line graphic risk assessment model based on this has good prediction and consistency,which may provide a basis for clinical practitioners to determine the risk of occurrence of moderate⁃to⁃severe pain in patients undergoing transperineal prostate biopsy.