下肢动脉硬化闭塞症患者介入术后复发风险的列线图模型构建及验证

Nomogram model construction and validation of interventional recurrence risk in aso patients

目的探讨构建下肢动脉硬化闭塞症(ASO)患者介入术后的预测模型预测患者介入术后复发的风险。方法纳入我院2020年7月—2022年9月血管外科经过介入治疗的病例170例为研究对象,收集患者一般资料,根据有无复发分为复发组(n=56)和非复发组(n=114)。根据Lasson回归筛选预测因子,再利用R软件建立列线图预测风险模型。用ROC曲线对该模型进行评估,并采用Bootstrap进行内部验证,计算C指数判断预测模型的区分度及模型校准度。结果单因素分析发现复发组和非复发组患者糖尿病、高血压、吸烟史、术后规律用抗血小板及降脂药、手术方式、钙化长度等影响因素比较,差异均有统计学意义(P<0.05)。根据Lasson回归筛选出糖尿病、高血压、吸烟史、术后规律用抗血小板及降脂药、手术方式、钙化长度6个预测因子,利用上述变量建立1年复发风险列线图预测模型,预测模型结果显示,ROC曲线提示AUC为0.754,原模型的C-index指数和Brier评分分别为0.765(95%CI:0.687~0.842)、0.172(95%CI:0.140~0.204),反复抽样500次以后的内部验证的C-index指数和Brier评分分别为:0.733(95%CI:0.623~0.842)、0.189(95%CI:0.139~0.246)。结论糖尿病、高血压、吸烟史、术后规律用抗血小板及降脂药、手术方式、钙化长度是影响ASO介入术后复发的重要影响因素。该模型能较好的评估患者介入治疗后的复发风险,具有一定的临床价值。

Objective To predict the risk of recurrence after interventional therapy in patients with arteriosclerosis obliterans(ASO)by constructing a nomogram risk model.Methods A total of 170 cases undergoing interventional therapy in our hospital from July 2020 to September 2022 were included as the study objects.General data of the patients were collected,and they were divided into a relapsed group(n=56)and a non-relapsed group(n=114)according to whether they had relapsed.Regression screening of predictors was conducted according to Lasson,and the risk prediction model was built with nomogram using R software.The ROC curve was used to evaluate the model,and Bootstrap was used for internal verification,and C-index was calculated to judge the differentiation degree and model calibration degree of the prediction model.Results Univariate analysis showed that there were statistically significant differences between the recurrence group and the non-recurrence group in diabetes,hypertension,smoking history,postoperative regular use of antiplatelet and lipidlowering drugs,operation method,length of calcification and other influencing factors(P<0.05).According to Lasson,six predictors of diabetes,hypertension,smoking history,postoperative regularity of antiplatelet and lipidlowering drugs,operation method,and calcification length were screened out by regression.A 1-year recurrence risk histogram prediction model was established using the above variables.The ROC curve indicated that AUC was 0.754.The C-index and Brier score of the original model are 0.765(95%CI:0.687~0.842)and 0.172(95%CI:0.140~0.204)respectively.The C-index and Brier score of the internal verification after repeated sampling for 500 times are as follows:0.733(95%CI:0.623~0.842),0.189(95%CI:0.139~0.246).Conclusion Diabetes,hypertension,smoking history,regular use of Antiplatelet drugs and lipid-lowering drugs after operation,operation mode and calcification length are important factors influencing the recurrence after ASO intervention.This model can better evaluate the recurrence risk of patients after interventional therapy,and has certain clinical value.