良性前列腺增生术后阴茎勃起功能障碍发生风险的列线图模型建立与风险分层

Establishment of a nomogram model and risk stratification for risk of erectile dysfunction after benign prostatic hyperplasia surgery

目的探讨良性前列腺增生(BPH)患者术后阴茎勃起功能障碍(ED)发生的风险因素,并建立列线图模型及风险分层标准,为临床防治ED提供参考。方法回顾性分析2021年1月至2023年6月新乡医学院第一附属医院收治的120例BPH术后患者的临床资料,根据术后是否发生ED分组,其中ED组60例,非ED组60例。比较两组患者的临床资料,采用Logistic回归方程分析BPH患者术后ED发生的影响因素,采用R-3.4.5软件语言建立列线图模型,绘制受试者工作特征曲线(ROC)、校准曲线、曲线下面积(AUC)、决策曲线(DCA)分析列线图模型预测效能,采用递归分割法建立ED发生风险分层系统。结果ED组患者中合并高血压、抑郁症、糖尿病、下尿路症状≥2项的例数占比分别为46.67%、31.67%、43.33%、45.00%,明显高于非ED组的28.33%、15.00%、23.33%、25.00%,差异均有统计学意义(P<0.05);ED组患者的一氧化氮(NO)、睾酮(T)水平分别为(40.42±5.56)nmol/mL、(2.11±0.60)μg/L,明显低于非ED组的(46.78±6.12)nmol/mL、(2.72±0.81)μg/L,而内皮素-1(ET-1)水平为(71.88±8.89)ng/L,明显高于非ED组的(60.02±10.23)ng/L,差异均有统计学意义(P<0.05);ED组患者收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)分别为(7.56±2.27)cm/s、(20.23±3.58)cm/s、0.59±0.17,明显小于非ED组的(10.22±2.69)cm/s、(25.51±4.36)cm/s、0.78±0.23,差异均有统计学意义(P<0.05);Logistic回归分析结果提示,高血压、抑郁症、糖尿病、NO、ET-1、T均是BPH术后ED发生风险的影响因素(P<0.05);基于上述影响因素构建的BPH术后ED发生风险的列线图预测模型的AUC为0.862,95%CI为0.796~0.927;DCA曲线显示该模型具有正向净获益;危险分层分析结果显示,高风险患者ED发生率为85.71%(36/42),高于中等风险的32.56%(14/43)和低风险的28.57%(10/35),差异有统计学意义(P<0.05)。结论高血压、抑郁症、糖尿病、NO、ET-1、T均是BPH术后ED发生风险的影响因素,基于上述影响因素建立的预测模型预测效能较高,基于预测模型的危险分层系统能较好地识别高危险患者,便于指导临床治疗。

Objective To explore the risk factors for the occurrence of erectile dysfunction(ED)in patients with benign prostatic hyperplasia(BPH)after surgery,and establish a nomogram model and risk stratification criteria to provide a reference for clinical prevention and treatment of ED.Methods The clinical data of 120 patients with BPH after surgery admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2021 to June 2023 were retrospectively analyzed.According to whether ED occurred after surgery,the patients were divided into two groups:60 patients in the ED group and 60 patients in the non-ED group.The clinical data of the two groups of patients were compared,and the Logistic regression equation was used to analyze the influencing factors of ED occurrence in BPH patients after surgery.The R-3.4.5 software language was used to establish a nomogram model,and the receiver operating characteristic(ROC)curve,calibration curve,area under the curve(AUC),decision curve analysis(DCA)were used to analyze the predictive efficacy of the nomogram model.The recursive partitioning method was used to establish a risk stratification system for ED occurrence.Results The proportions of patients with hypertension,depression,diabetes,and lower urinary tract symptoms in the ED group were 46.67%,31.67%,43.33%,and 45.00%,respectively,which were significantly higher than 28.33%,15.00%,23.33%,and 25.00%in the non-ED group(P<0.05).The levels of nitric oxide(NO)and testosterone(T)in the ED group were(40.42±5.56)nmol/mL and(2.11±0.60)μg/L,respectively,which were significantly lower than(46.78±6.12)nmol/mL and(2.72±0.81)μg/L in the non-ED group,while the level of endothelin-1(ET-1)was(71.88±8.89)ng/L,which was significantly higher than(60.02±10.23)ng/L in the non-ED group, with statistically significant differences (P<0.05). The systolic peak flow velocity (PSV), end diastolic velocity(EDV), and resistance index (RI) in the ED group were (7.56±2.27) cm/s, (20.23±3.58) cm/s, and 0.59±0.17, respectively,which were significantly lower than (10.22±2.69) cm/s, (25.51±4.36) cm/s, and 0.78±0.23 in the non-ED group (P<0.05). The results of logistic regression analysis suggested that hypertension, depression, diabetes, NO, ET-1, and T wereall risk factors for the occurrence of ED after BPH surgery (P<0.05). The AUC of the nomogram prediction model basedon these risk factors was 0.862, with a 95%CI of 0.796-0.927. DCA showed that the model had a positive net benefit. The riskstratification analysis showed that the incidence of ED in high-risk patients was 85.71% (36/42), which was significantly higherthan that in moderate-risk patients (32.56%, 14/43) and that in low-risk patients (28.57%, 10/35), P<0.05. Conclusion Hypertension,depression, diabetes, NO, ET-1, and T are the factors affecting the risk of ED after BPH surgery. The predictionmodel established based on the above factors has high predictive efficacy, and the risk stratification system based onthe prediction model can better identify high-risk patients and facilitate clinical treatment.