目的:随着分析方法的发展,基于体液生物标志物的数学模型在医学领域的应用越来越广泛。本研究旨在探讨前列腺肿大患者经尿道前列腺电切术(TURP)后发生膀胱痉挛的危险因素。然后构造一个列线图模型。
方法:纳入了接受TURP的242例前列腺肿大患者。根据术后是否发生膀胱痉挛分为痉挛组(n=65)和无痉挛组(n=177)。采用酶联免疫法测定血清前列环素(PGI2)和5-羟色胺(5-HT)水平。采用单因素和多因素logistic回归分析危险因素。
结果:痉挛组患者术后血清PGI2和5-HT水平高于非痉挛组(P<0.05)。术前焦虑,引流管阻塞,术后PGI2和5-HT水平升高是TURP术后膀胱痉挛的独立危险因素(P<0.05)。模型的C指数为0.978(0.959-0.997),Hosmer-Lemeshow拟合优度检验的χ2=4.438(p=0.816)。评估列线图模型的区分的ROC曲线显示0.978(0.959-0.997)的AUC。
结论:术前焦虑,引流管阻塞,术后血清PGI2和5-HT水平升高是TURP术后膀胱痉挛的独立危险因素。基于上述独立危险因素的列线图模型具有较好的判别能力和预测能力,为临床上预测膀胱痉挛的发生提供了较高的指导价值。
OBJECTIVE: With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder
spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model.
METHODS: Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into
Spasm group (n=65) and non-
spasm group (n=177) according to whether they had bladder
spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors.
RESULTS: Postoperative serum PGI2 and 5-HT levels were higher in patients in the
Spasm group compared with the Non-
spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997).
CONCLUSIONS: Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.