小肠出血手术治疗选择的预测模型

Predictive Model for Surgical Treatment Options for Small Bowel Bleeding

摘要: 目的：探讨小肠出血手术治疗的影响因素，同时建立手术治疗选择的预测模型，为临床决策提供参考。方法：回顾性收集新疆医科大第一附属医院2014年3月至2023年3月期间收治且符合本研究纳入和排除标准的小肠出血患者，根据治疗方式选择分为手术治疗和保守治疗，比较手术治疗和保守治疗患者临床病理因素方面的差异，同时将其有统计学意义(P < 0.05)的因素或基于专业知识判断可能有临床意义的因素纳入进行多因素logistic回归分析，以筛选影响手术治疗选择的因素，并且采用筛选出的影响因素构建logistic回归预测模型方程，采用受试者操作特征曲线下面积及其95%可信区间评估该预测模型方程的预测效能。结果；共纳入121例小肠出血患者，其中行手术治疗患者63例(52.0%)、行保守治疗患者58例(47.9%)。手术治疗和保守治疗患者在15个临床病理因素方面比较差异有统计学意义(P < 0.05)，如脉搏，舒张压，红细胞计数，血红蛋白，红细胞压积，中性粒细胞计数，白细胞计数，降钙素原，白蛋白，ALT，钙，血糖，INR，休克指数，贫血，对此进一步进行多因素logistic回归分析结果显示，白细胞计数、白蛋白(β = 0.150, P = 0.001)，休克指数(β = 3.180, P = 0.028)，对小肠出血患者是否采用手术治疗产生正向影响，而红细胞压积(β = −0.081, P = 0.036)、ALT (β = −0.039, P = 0.045)、钙(β = −3.994, P = 0.043)，对小肠出血患者是否采用手术治疗产生负向影响。根据这6个影响因素我们构建的手术选择模型曲线下面积为0.857，特异度为91.4%，灵敏度为69.8%。结论：从本研究初步研究结果提示，对伴术前白细胞计数、低蛋白水平、休克指数高，术前红细胞压积低、ALT高、术前低钙的小肠出血患者建议采用手术治疗，并且本研究根据这些特征构建的logistic预测模型方程对采用手术治疗或保守治疗患者具有较好的区分度。

Abstract: Objective: To investigate the influencing factors of small intestine hemorrhage and establish the prediction model of surgical treatment selection to provide reference for clinical decision. Methods: Patients with small bowel bleeding who were admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2014 to March 2023 and met the inclusion and exclusion criteria of this study were retrospectively collected. According to the treatment mode selection is divided into surgical treatment and conservative treatment, comparing differences in clinicopathological factors between patients treated surgically and conservatively. The factors that were statistically significant (P < 0.05) or the factors that may be clinically significant based on professional knowledge were also included in the multivariate logistic regression analysis. To screen for factors influencing the choice of surgical treatment, and to construct the logistic regression prediction model equation by using the selected influencing factors, the prediction efficacy of the prediction model equation was evaluated using the area under the subject operating characteristic curve and its 95% confidence interval. Results: A total of 121 patients with small bowel bleeding were included, of which 63 (52.0%) underwent surgical treatment and 58 (47.9%) underwent conservative treatment. Among 15 clinicopathological factors (P < 0.05), such as the pulse, diastolic pressure, RBC, hemoglobin, hematocrit, Neutrophil count, leucocyte count, Procalcitonin, albumin, ALT, Calcium, blood glucose, INR, shock index, anemia, the results of the multivariate logistic regression analysis performed on this step further show that, white blood cell count, albumin (β = 0.150, P = 0.001), shock index (β = 3.180, P = 0.028), positive impact on whether patients with small bowel bleeding, and the hematocrit (β = −0.081, P = 0.036), ALT (β = −0.039, P = 0.045), calcium (β = −3.994, P = 0.043). It has a negative effect on patients with small bowel bleeding. According to these six influencing factors, we constructed the surgical selection model with area under the curve of 0.857, specificity 91.4%, and sensitivity 69.8%. Conclusion: The results from the preliminary study of this study suggest that surgical treatment is recommended for patients with preoperative white blood cell count, low protein level, high shock index, low preoperative hematocrit, high ALT, and low preoperative calcium, and the logistic prediction model equation constructed in this study based on these characteristics has a good differentiation for patients with surgical treatment or conservative treatment.