摘要
目的探讨子宫动脉栓塞术(UAE)治疗剖宫产瘢痕妊娠(CSP)危险因素,构建列线图预测模型,为患者个体化治疗提供依据。方法回顾性分析2014年1月至2023年6月山西白求恩医院收治的305例CSP患者临床资料。采用多因素logistic回归分析CSP患者行UAE独立危险因素,构建风险预测模型。用R语言软件绘制列线图,受试者工作特征曲线(ROC)评价模型预测能力。对模型进行验证和校准,并通过决策曲线分析(DCA)法分析其临床效用。结果305例患者中88例(28.85%)接受介入治疗,217例(71.15%)未接受介入治疗。单因素和多因素分析显示,孕囊直径(OR:1.062,95%CI:1.034~1.091,P=0.001)、腹痛(OR:0.179,95%CI:0.085~0.379,P=0.001)、残余肌层厚度<3 mm(OR:6.532,95%CI:3.271~13.043,P=0.001)是CSP患者行UAE独立危险因素。建立了风险预测模型[h(t,X)=h0(t)exp(-1.718X_(1)+1.877X_(2)+0.061X_(3))],以列线图形式呈现。ROC曲线分析显示,模型总体预测效能显著优于单个危险因素预测,且模型Hosmer-Lemeshow检验具较好拟合度。一致性指数(C-index)为0.828,表现出良好区分度。经Bootstrap法校正后,该模型具有较高的预测准确性。DCA曲线评价该模型显示具有良好的临床效用价值。结论基于有无腹痛、孕囊直径、残余肌层厚度构建的风险预测模型列线图具有较高的准确度和区分度,一致性良好。该模型临床效用性良好,可用于预测评估CSP患者是否存在UAE风险。
Objective To investigate the risk factors of uterine artery embolization(UAE)in treating cesarean scar pregnancy(CSP),and to construct a nomogram prediction model used for providing a basis for individualized treatment.Methods The clinical data of 305 CSP patients,who were admitted to the Shanxi Bethune Hospital from January 2014 to June 2023,were retrospectively analyzed.Multivariate logistic regression was used to analyze the independent risk factors for UAE in patients with CSP,based on which a risk prediction model was constructed.R language was used to draw a nomogram.The receiver operating characteristic(ROC)curve was used to evaluate the predictive power of the model.The model was verified and calibrated,and the decision curve analysis(DCA)curve was drawn to analyze its clinical utility.Results Of the 305 CSP patients,88(28.85%)received interventional operation and 217(71.15%)did not receive interventional operation.Univariate and multivariate analysis showed that gestational sac diameter(OR=1.062,95%CI=1.034-1.091,P=0.001),abdominal pain(OR=0.179,95%CI=0.085-0.379,P=0.001),residual muscle thickness(OR=6.532,95%CI=3.271-13.043,P=0.001),were the independent risk factor for UAE in CSP patients(P<0.05).The following risk prediction model was established:h(t,X)=ho(t)exp(-1.718X_(1)+1.877X_(2)+0.061X_(3)),which was presented as a nomogram,ROC curve analysis indicated that the overall prediction efficiency of the model was better than that of a single risk factor,and the Hosmer-Lemeshow test of the model had a better fit degree.The consistency index(C-index)was O.828,suggesting that this model had good discrimination ability.After correction by the Bootstrap method,this model had a relatively high prediction accuracy.DCA curve evaluation revealed that this model had good clinical utilization value.Conclusion The nomogram of the risk prediction model,which is constructed based on the presence or absence of abdominal pain,gestational sac diameter and residual muscle thickness,has high accuracy and differentiation with a good consistency.This model has good clinical utilization value and it can be used to predict and evaluate whether a patient with CSP is at risk of UAE.
作者
郭晓云
韩敏
王赞宏
于冰
GUO Xiaoyun;HAN Min;WANG Zanhong;YU Bing(Department of Gynaecology and Obstetrics,Third Hospital of Shanzi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanri Hospital),Taiyuan,Shanxi Province 030032,China)
出处
《介入放射学杂志》
CSCD
北大核心
2024年第8期890-895,共6页
Journal of Interventional Radiology
关键词
剖宫产瘢痕妊娠
子宫动脉栓塞术
介入治疗
列线图
cesarean scar pregnancy
uterine artery embolization
interventional treatment
nomogram
