结直肠腺瘤患者消化内镜切除术后再发预测模型构建及预防干预措施分析OA

Objective To explore the construction of a recurrence prediction model and preventive intervention measures for colorectal adenoma after endoscopic resection.Method Retrospective collection of clinical data from 183 patients with colorectal adenomas who underwent endoscopic resection at The Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Provincial Hospital of Traditional Chinese Medicine)from February 2021 to December 2022 was included in the modeling group.Collect clinical data of 117 patients with colorectal adenomas who underwent endoscopic resection at The Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Provincial Hospital of Traditional Chinese Medicine)from January to December 2023 and include them in the validation group.Follow up for 24 months and record the recurrence of colorectal adenomas.Using multiple Logistic regression analysis to identify independent risk factors for recurrence in patients with colorectal adenoma after endoscopic resection.Build a Nomogram prediction model based on risk factors.Draw receiver operator characteristic curve(ROC curve)to evaluate the discriminative power of the model;Hosmer-Lemeshow goodness of fit test evaluation model calibration degree;draw decision curve analysis(DCA)to evaluate the clinical applicability of the model.Result Among the 183 patients in the modeling group,62 cases had recurrence,with an incidence rate of 33.88%(recurrent group).Univariate analysis showed that there were no significant differences between the recurrent group and the non recurrent group in gender,hypertension,hyperlipidemia,drinking history and lesion location(all P＞0.05),but there were significant differences between the age,diabetes mellitus,smoking history,adenoma size,number of adenomas,pathological type and histological grading groups(all P＜0.05).Multivariate Logistic regression analysis showed that age,smoking history,adenoma size,number of adenomas,pathological type and histological grading were independent risk factors for recurrence of colorectal adenoma after endoscopic resection(all P＜0.05).The ROC curve was used to evaluate the discrimination of the column chart model.The area under the curve(AUC)of the modeling group was 0.960(95%CI:0.924-0.996),with specificity and sensitivity of 95.00%and 87.50%,respectively;the AUC of the validation group was 0.949(95%CI:0.905-0.994),with specificity and sensitivity of 95.50%and 85.60%,respectively.The Hosmer-Lemeshow goodness of fit test and calibration curve were used to evaluate the calibration of the model.The results showed that the consistency index of the modeling group χ2=5.41,P=0.78＞0.05,and the validation group χ2=7.01,P=0.54＞0.05.The clinical utility of the DCA evaluation model was evaluated,and the threshold values of the modeling and validation datasets were within the range of 1%to 99%.The net benefit curve of the model was higher than both the"all intervention"and"all non intervention"strategy lines.Conclusion The recurrence rate of colorectal adenoma after endoscopic resection is relatively high and is influenced by multiple factors.Constructing a predictive model can help identify high-risk patients early and take targeted preventive interventions.