高原地区内镜微创保胆取石术后结石复发新型预测列线图的构建和验证

目的对内镜微创保胆取石术后结石复发相关因素进行分析,根据独立危险因素,建立预测术后结石复发风险的列线图模型。方法回顾性分析2012年1月—2018年1月在青海大学附属医院接受内镜微创保胆取石术的144例胆囊结石患者的临床资料。根据术后结石复发情况将患者分为无复发组(n=130)和复发组(n=14)。两组间计数资料比较采用χ2检验。通过LASSO和logistic回归分析评价患者术后结石复发的独立风险因素,根据回归系数绘制相应的列线图预测模型。通过绘制校准曲线评估预测列线图的可靠性;采用Harrell一致性指数以量化预测列线图的判别性能;通过受试者工作特征曲线来评估该预测模型的灵敏度、特异度,计算曲线下面积(AUC)。结果144例患者内镜微创保胆取石术手术均获得成功,其中14例(9.7%)术后复发结石。通过多因素分析确定了4个影响复发的独立危险因素,分别为家族史(OR=3.245,95%CI:0.752~13.567,P=0.104)、饮食的规律性(OR=3.752,95%CI:1.067~14.141,P=0.041)、结石的均一性(OR=5.871,95%CI:1.636~25.390,P=0.010)和药物依从性(OR=0.225,95%CI:0.057~0.799,P=0.024)。列线图模型在建模样本中的一致性系数(C-index)为0.835(95%CI:0.732~0.938),在验证样本中的C-index为0.7925,说明本研究列线图模型具有良好的精准度和区分度。预测列线图的AUC值为0.835,表明该列线图预测价值较高。结论家族史、饮食的规律性、胆结石的均一性和药物依从性是内镜微创保胆取石术后结石复发的独立危险因素,根据上述独立危险因素建立的列线图有助于预测术后结石复发的风险。

Construction and verification of a new nomogram for predicting stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy at high altitude

Objective To investigate related factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy,and to establish a nomogram model for predicting the risk of stone recurrence after surgery based on independent risk factors.Methods A retrospective analysis was performed for the clinical data of 144 patients with gallstones who underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy in Qinghai University Affiliated Hospital from January 2012 to January 2018,and according to postoperative stone recurrence,the patients were divided into non-recurrence group and recurrence group.The chi-square test was used for comparison of categorical data between two groups.LASSO and logistic regression analyses were used to analyze independent risk factors for postoperative stone recurrence,and the corresponding nomogram prediction model was plotted according to regression coefficient.The calibration curve was plotted to evaluate the reliability of the predictive nomogram;Harrell consistency index was used to quantify the discriminatory performance of the predictive nomogram;the receiver operating characteristic(ROC)curve was used to evaluate the sensitivity,specificity,and area under the ROC curve(AUC)of this predictive nomogram.Results All 144 patients underwent successful endoscopic minimally invasive gallbladder-preserving cholecystolithotomy,among whom 14 patients(9.7%)experienced stone recurrence after surgery.The multivariate analysis showed that family history(odds ratio[OR]=3.245,95%confidence interval[CI]:0.752-13.567,P=0.104),regular diet(OR=3.752,95%CI:1.067-14.141,P=0.041),stone homogeneity(OR=5.871,95%CI:1.636-25.390,P=0.010),and medication compliance(OR=0.225,95%CI:0.057-0.799,P=0.024)were independent risk factors for recurrence.The nomogram model had an index of concordance(C-index)of 0.835(95%CI:0.732-0.938)in the modeling sample and 0.7925 in the verification sample,suggesting that the nomogram model in this study had good accuracy and discrimination.The predictive nomogram had an AUC of 0.835,suggesting that this nomogram had a relatively high predictive value.Conclusion Family history,regular diet,stone homogeneity,and medication compliance are independent risk factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy,and the nomogram constructed based on these independent risk factors may help to predict the risk of postoperative stone recurrence.