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口腔癌患者术后营养不良风险的列线图模型构建

Construction of a risk nomogram model of postoperative malnutrition in patients with oral cancer

    摘要
  • 摘要:
    目的 分析口腔癌患者术后发生营养不良的影响因素并构建列线图预测模型。
    方法 选取117例口腔癌患者为研究对象，根据患者是否存在营养不良分为非营养不良组(n=46)与营养不良组(n=71)。采用Logistic回归分析法分析口腔癌患者术后发生营养不良的影响因素。构建预测口腔癌患者术后营养不良风险的列线图模型，并采用受试者工作特征(ROC)曲线、校准曲线和Hosmer-Lemeshow拟合优度检验评估列线图模型应用价值。
    结果 117例口腔癌患者中，营养不良患者占60.68%(71/117)。Logistic回归分析显示，年龄>60岁(95%CI: 2.220~29.647, P=0.002)、入院时营养风险筛查结果为有营养风险(95%CI: 2.586~39.175, P=0.001)、气管切开(95%CI: 1.582~15.312, P=0.006)、术后抑郁(95%CI: 2.253~27.327, P=0.001)、术后睡眠障碍(95%CI: 3.014~43.037, P<0.001)和术后吞咽障碍(95%CI: 2.943~38.493, P<0.001)是口腔癌患者术后发生营养不良的影响因素。构建的列线图预测模型的ROC曲线下面积为0.888(95%CI: 0.823~0.953); 校准曲线显示，预测概率曲线与实际概率曲线基本吻合，且Hosmer-Lemeshow拟合优度检验χ2=6.515, P=0.481。
    结论 年龄>60岁、入院时营养风险筛查结果为有营养风险、气管切开、术后抑郁、术后睡眠障碍和术后吞咽障碍是口腔癌患者术后发生营养不良的影响因素。基于上述因素构建的列线图模型具有良好的区分度和一致性。

     

    Abstract:
    Objective To analyze the influencing factors of malnutrition after surgery in patients with oral cancer and construct a nomogram prediction model.
    Methods A total of 117 patients with oral cancer were selected as the research subjects and divided into non-malnutrition group (n=46) and malnutrition group (n=71) based on whether they were malnourished. Logistic regression analysis was used to analyze the influencing factors of postoperative malnutrition in patients with oral cancer. A nomogram model was constructed to predict the risk of postoperative malnutrition in patients with oral cancer, and the application value of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness-of-fit test.
    Results Among the 117 patients with oral cancer, 60.68% (71/117) were malnourished. Logistic regression analysis showed that age >60 years (95%CI, 2.220 to 29.647, P=0.002), nutritional risk screening result at admission indicating nutritional risk (95%CI, 2.586 to 39.175, P=0.001), tracheotomy (95%CI, 1.582 to 15.312, P=0.006), postoperative depression (95%CI, 2.253 to 27.327, P=0.001), postoperative sleep disorder (95%CI, 3.014 to 43.037, P<0.001) and postoperative swallowing disorder (95%CI, 2.943 to 38.493, P<0.001) were the influencing factors of postoperative malnutrition in patients with oral cancer. The area under the ROC curve of the constructed nomogram prediction model was 0.888 (95%CI, 0.823 to 0.953); the calibration curve showed that the predicted probability curve basically matched the actual probability curve, and the Hosmer-Lemeshow goodness-of-fit test was well (χ2=6.515, P=0.481).
    Conclusion Age >60 years, nutritional risk screening result indicating nutritional risk at admission, tracheotomy, postoperative depression, postoperative sleep disorder and postoperative swallowing disorder are the influencing factors of postoperative malnutrition in patients with oral cancer. The nomogram model constructed based on the above factors has good discrimination and consistency.

     

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