结直肠癌造口病人心理障碍预测模型构建分析

目的探讨结直肠癌造口病人心理障碍预测模型构建。方法选取290例结直肠癌造口病人作为调查对象，随机选取70%(203例)的病例作为训练集，30%(87例)作为测试集，根据明尼苏达多相人格测试(MMPI)分为心理障碍组(MMPI≥60分)和非心理障碍组(MMPI < 60分)，比较训练集中2组一般资料情况，应用logistic回归模型分析影响结直肠癌造口病人心理障碍相关因素，采用R软件基于训练集建立列线图预测模型，并在测试集评估模型效能。结果剔除无效问卷2份(训练集、测试集各1例)，最终获得有效问卷288份，有效回收率为99.31%，其中训练集最终纳入202例，心理障碍组67例(33.17%)，非心理障碍组135例(66.83%)，2组性别、造口时间、自我管理能力评分、社会支持评定量表(SSRS)评分、造口并发症比较差异均有统计学意义(P < 0.05~P < 0.01)；多因素logistic分析显示，性别为女性、造口时间长、自我管理能力评分高、SSRS评分高为结直肠癌造口病人心理障碍的保护因素，造口并发症为结直肠癌造口病人心理障碍发生的危险因素(P < 0.05~P < 0.01)，上述因素预测结直肠癌造口病人心理障碍相关因素的一致性指数为0.804(95%CI: 0.743~0.857)，ROC曲线进一步验证显示，特异度88.50%，敏感度81.60%。外部验证显示该预测模型敏感性为85.71%，特异性为87.93%。结论结直肠癌造口病人心理障碍情况较为严峻，性别、自我管理能力、社会支持、造口并发症、造口时间是心理障碍的影响因素，由此构建的预测模型具有较高的应用价值。

Construction and analysis of the prediction model of psychological disorder in colorectal cancer patients with enterostomy

ObjectiveTo explore the construction of a prediction model of psychological disorders in colorectal cancer patients with enterostomy.MethodsA total of 290 colorectal cancer patients with enterostomy were investigated, and randomly set the training set(203 cases) and test set(87 cases). According to the Minnesota multiphasic personality inventory(MMPI), the patients were divided into the psychological disorder group(MMPI≥60 points) and non-psychological disorder group(MMPI < 60 points). The general data in the training set were compared between two groups, the related factors affecting the psychological disorders of colorectal cancer patients with enterostomy were analyzed using the logistic regression model. The R software was used to establish a nomogram prediction model based on the training set, and the effectiveness of model in the test set was evaluated.ResultsTwo invalid questionnaires(one in the training set and one in the test set) were eliminated, and 288 valid questionnaires were obtained with effective recovery rate of 99.31%. Two hundred and two cases were included in the training set, and 67 cases(33.17%) in the psychological disorder group and 135 cases(66.83%) in the non-psychological disorder group were identified. The differences of the gender, enterostomy time, self-management ability score, social support rating scale(SSRS) score and enterostomy complications between two groups were statistically significant(P < 0.05 to P < 0.01). The results of multivariate logistic analysis showed that female, long time of enterostomy, high score of self-management ability and high score of SSRS were the protective factors of psychological disorders, and the enterostomy complication was the risk factor of psychological disorders in colorectal cancer patients with enterostomy(P < 0.05 to P < 0.01). The consistency index of the above factors in predicting psychological disorders in colorectal cancer patients with enterostomy was 0.804(95%CI: 0.743-0.857). The results of further verification by ROC curve showed that the specificity was 88.50%, and the sensitivity was 81.60%. The results of external validation showed that the sensitivity and specificity of this model were 85.71% and 87.93%, respectively.ConclusionsThe psychological disorder of colorectal cancer patients with enterostomy is more severe. The gender, self-management ability, social support, enterostomy complications and time are the influencing factors of psychological disorder. The prediction model has high application value.