前列地尔联合罂粟碱在IC保守治疗中的临床价值及Nomogram的构建

Clinical Value of Alprostadil Combined with Popaverine in Conservative Treatment of Ischemic Colitis and Establishment of a Nomogram Prediction Model

摘要: 目的：探讨影响缺血性结肠炎患者保守治疗效果的相关因素，评估前列地尔联合罂粟碱在保守治疗中的临床价值，并构建保守治疗效果的个体化列线图预测模型(Nomogram)。方法：本研究共选取2018年1月至2021年1月于青岛大学附属医院收治的98例缺血性结肠炎患者，随机分为观察组和对照组，对照组给予常规保守治疗，观察组在其基础上加用前列地尔联合罂粟碱治疗，主要研究终点是IC患者保守治疗一周后的效果；分析影响保守治疗效果的相关因素，应用R软件绘制基于Logistic回归分析保守治疗效果的预测模型，绘制ROC曲线评估模型的区分度，绘制校准曲线评估模型的校准度。结果：保守治疗一周后，观察组治疗有效率为93.88%，对照组治疗有效率71.43%，差异有统计学意义，观察组中腹痛消失的时间为3.24 ± 1.73 d，腹泻消失的时间为2.42 ± 1.08 d，大便潜血阳性消失的时间为3.92 ± 1.15 d，住院时间为9.80 ± 2.80 d，均小于对照组；将治疗效果作为结局变量，单因素分析显示治疗有效组入院白细胞计数、中性粒细胞百分比，中性粒细胞计数、C反应蛋白、降钙素原水平均低于无效组，差异有统计学意义(P < 0.05)；有效组中联合应用前列地尔及罂粟碱患者所占的比例(56.79%)大于无效组(17.65%)，且差异有统计学意义(P < 0.05)；多因素Logistic回归分析显示，入院CRP，PCT水平以及治疗方式是保守治疗有效率的独立影响因素(P < 0.05)。构建保守治疗有效率的列线图预测模型，ROC曲线显示模型具有良好的区分度(AUC = 0.963, (95%CI: 0.928~0.998))，校准曲线显示模型具有良好的校准度。结论：前列地尔联合罂粟碱缩短了缺血性结肠炎患者临床症状的缓解时间及住院时间，增加了治疗有效率，且无严重不良反应，可在IC患者中安全应用，本研究构建的列线图模型可个体化预测IC患者保守治疗的效果，帮助医生和患者选择合理的治疗决策。

Abstract: Objective: To explore the factors affecting conservative treatment in patients with ischemic colitis, assess the value of leading alprostadil combined with popaverine in conservative treatment and construct an individualized linographic prediction model for the effect of conservative treatment. Methods: This study included 98 patients with ischemic colitis admitted from the Affiliated Hospital of Qingdao University from January 2018 to January 2021, who were randomly divided into observation group and control group. The control Group was given routine conservative treatment, and the observation group was additionally treated with alprostadil combined with papaverine. The primary endpoint was the effect after 1 week of conservative treatment in patients with IC. Independent-sample T test was used to compare the measurement data, ² test was used to compare the counting data. R software was used to drawn the prediction model based on logistic regression analysis of conservative treatment effect. Calibration curve was drawn to analyze the calibration degree of the model, and ROC curve was drawn to evaluate the discrimination degree of the model. Results: After 1 week of conservative treatment, the effective rate of the observation group was 93.88%, and that of the control group was 71.43%, the difference was statistically significant. In the observation group, the disappearance time of abdominal pain was 3.24 ± 1.73 days, the disappearance time of diarrhea was 2.42 ± 1.08 days, the disappearance time of stool occult blood test positive was 3.92 ± 1.15 days, and the hospitalization time was 9.80 ± 2.80 days, less than that in the control group. Univariate analysis showed that admission WBC, NE, NE%, CRP and PCT in the effective group were lower than those in the ineffective group, the difference was statistically significant (P < 0.05). Multivariate logistic regression analysis showed that admission CRP, PCT and treatment mode were independent influencing factors of conservative treatment efficiency (P < 0.05). Nomogram prediction model of conservative treatment efficiency was constructed. The ROC curve showed that the model had good discrimination (AUC = 0.963, (95%CI: 0.928~0.998)), and the calibration curve showed that the model had good calibration. Conclusion: Alprostadil combined with papaverine can shorten the remission time of clinical symptoms and hospitalization time of patients with IC, increase the treatment efficiency, and have no serious adverse reactions, which can be safely applied in patients with IC. The nomogram model constructed in this study can predict the effect of conservative treatment of patients with IC individually, and help doctors and patients choose reasonable treatment decisions.