早期结直肠癌内镜下黏膜剥离术后感染危险因素及风险预测模型构建

Risk Factors for Infection After Endoscopic Submucosal Dissection for Early Colorectal Cancer and Construction of a Risk Prediction Model

目的通过分析早期结直肠癌内镜下黏膜剥离术后感染的危险因素,构建术后感染发生风险的预测模型并进行验证,为临床早期预防及治疗提供一定依据。方法选取行内镜下黏膜剥离术治疗的96例结直肠癌患者的临床资料进行回顾性分析,根据术后是否发生感染分为感染组与未感染组。利用单因素分析及多因素logistic回归分析明确结直肠癌内镜下黏膜剥离术后感染的危险因素,构建风险预测模型,并绘制受试者工作特征(ROC)曲线对其预测效能进行验证。结果96例结直肠癌患者行内镜下黏膜剥离术后发生感染11例,发生率为11.46%,感染类型主要为泌尿系统感染,其次为腹腔感染、肺部感染。单因素分析及多因素logistic回归分析结果显示,年龄(X1)、合并糖尿病(X2)、术前低蛋白血症(X3)、手术时间(X4)、术后穿孔(X5)均是早期结直肠癌内镜下黏膜剥离术后感染的影响因素(P<0.05)。建立的预测模型方程:Logit(P)=-11.368+0.367X1+0.563X2+0.656X3+0.515X4+0.750X5。预测模型方程验证结果显示,C-index指数为0.853(95%CI:0.706~0.911),模型拟合度较好。ROC曲线结果显示,曲线下面积为0.882(95%CI:0.789~0.975),SE为0.048,约登指数为0.677,灵敏度与特异度分别为83.3%、80.2%,预测模型预测效能较好。结论年龄、合并糖尿病、术前低蛋白血症、手术时间、术后穿孔均是早期结直肠癌内镜下黏膜剥离术后感染的影响因素,以此建立的预测模型拟合度、预测效能及临床价值均较好,可为临床预防的制定提供指导。

Objective To screen the risk factors for infection after endoscopic submucosal dissection for early colorectal cancer and to construct and validate a risk prediction model for postoperative infection,thus providing a certain basis for clinical early prevention and treatment.Methods Clinical data of 96 patients who underwent endoscopic submucosal dissection for early colorectal cancer were retrospectively analyzed,and patients were classified into infection group and non-infection group according to the presence or absence of postoperative infection.The risk factors of postoperative infection after endoscopic submucosal dissection for colorectal cancer were identified via univariate and multivariate Logistic regression analysis.Then a risk prediction model was constructed and the predictive efficacy was validated using receiver operating characteristic(ROC)curve.Results Postoperative infection occurred in 11 of 96 patients with colorectal cancer after endoscopic submucosal dissection,with an incidence rate of 11.46%.The types of infections were predominantly urinary tract infections,followed by abdominal infections and lung infection.Univariate and multivariate Logistic regression analysis denoted that age(X1),comorbid diabetes mellitus(X2),preoperative hypoproteinemia(X3),operation time(X4)and postoperative perforation(X5)were all risk factors for postoperative infection after endoscopic submucosal dissection for early colorectal cancer(P<0.05).Establishment of the regression equation was Logit(P)=-11.368+0.367X1+0.563X2+0.656X3+0.515X4+0.750X5.The validation of the prediction model equations showed a good model fit with a C-index of 0.853(95%CI:0.706 to 0.911).ROC curve indicated that the area under the curve,standard error(SE),Youden index,sensitivity and specificity of the model was 0.882(95%CI:0.789~0.975),0.048,0.677,83.3%and 80.2%,suggesting that the prediction model had good predictive efficacy.Conclusion Age,comorbid diabetes mellitus,preoperative hypoproteinemia,operation time and postoperative perforation are all risk factors for postoperative infection after endoscopic submucosal dissection for early colorectal cancer.The established risk prediction model shows a good fit,predictive efficacy and clinical value,which can provide guidance for the formulation of clinical prevention measures.