下肢静脉溃疡延迟愈合风险预测模型的构建与验证

doi:10.3761/j.issn.0254-1769.2024.13.010

摘要/Abstract

摘要：

目的构建并验证下肢静脉溃疡（venous leg ulcer，VLU）延迟愈合风险预测模型，为早期识别延迟愈合高风险人群提供借鉴。方法采用便利抽样方法，选取2018年1月—2022年12月在四川省2所三级甲等医院血管外科就诊的331例VLU患者作为建模组，选取另1所三级甲等医院收治的112例患者作为验证组。采用单因素分析、最小绝对值收敛和选择算子回归、多因素Logistic回归分析筛选VLU延迟愈合的危险因素，使用R软件构建预测模型，采用受试者操作特征曲线下面积、Hosmer-Lemeshow检验及临床决策曲线综合评价模型的预测性能，并分别进行Bootstrap重抽样内部验证和空间外部验证。结果最终纳入模型的预测变量为糖尿病（OR=4.752）、下肢深静脉血栓（OR=4.104）、皮肤脂质硬化（OR=5.405）、溃疡复发（OR=3.239）、踝关节活动（OR=5.520）。该模型具有较好的区分度（受试者操作特征曲线下面积：内部验证为0.819，外部验证为0.858）、校准度（Hosmer-Lemeshow检验：内部验证χ²=13.517，P=0.095；外部验证χ²=3.375，P=0.909）和临床有效性。结论该研究构建的VLU延迟愈合风险预测模型具有较好的区分度和校准度，可以有效预测VLU延迟愈合高风险人群，有利于临床采取针对性干预措施改善溃疡结局，降低溃疡延迟愈合风险。

关键词: 下肢静脉溃疡, 延迟愈合, 危险因素, 预测模型, 护理

Abstract:

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer （VLU），so as to provide a reference basis for early identification of people at high risk of delayed healing. Methods Using a convenience sampling method，331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group，and 112 patients admitted to another tertiary A hospital were selected as an external validation group. Risk factors for delayed healing in VLU patients were screened using univariate analysis，LASSO regression，and multivariate logistic regression analysis，and a risk prediction model was constructed using R software，and the predictive effects of the models were examined using the area under the receiver operating characteristic curve，the Hosmer-Lemeshow test，decision curve，and the bootstrap resampling for internal validation and spatial external validation were performed，respectively. Results The predictors that ultimately entered the prediction model were diabetes（OR=4.752），deep vein thrombosis（OR=4.104），lipodermatosclerosis（OR=5.405），ulcer recurrence（OR=3.239），and ankle mobility（OR=5.520）. The model had good discrimination（AUC：0.819 for internal validation and 0.858 for external validation），calibration（Hosmer-Lemeshow test：χ²=13.517，P=0.095 for internal validation and χ²=3.375，P=0.909 for external validation） and clinical validity. Conclusion The model constructed in this study has good differentiation and calibration，and it can effectively predict people at high risk of delayed healing of VLU，which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Key words: Venous Leg Ulcers, Delayed Healing, Risk Factors, Prediction Model, Nursing Care

黄思源, 刘芯君, 杨曦, 张明凤, 王丹, 熊华容, 姚佐懿, 石镁虹. 下肢静脉溃疡延迟愈合风险预测模型的构建与验证[J]. 中华护理杂志, 2024, 59(13): 1600-1607.

HUANG Siyuan, LIU Xinjun, YANG Xi, ZHANG Mingfeng, WANG Dan, XIONG Huarong, YAO Zuoyi, SHI Meihong. Construction and validation of a risk prediction model for the delayed healing of venous leg ulcers[J]. Chinese Journal of Nursing, 2024, 59(13): 1600-1607.

图/表 5

表1 下肢静脉溃疡患者的一般资料与溃疡延迟愈合的单因素分析（n=331）

Table 1 Univariate analysis of delayed healing occurring in patients with VLU in the training set（n=331）

表2 下肢静脉溃疡延迟愈合的LASSO回归分析

Table 2 LASSO regression analysis of delayed healing occurring in VLU patients

表3 下肢静脉溃疡延迟愈合的Logistic回归分析

Table 3 Results of Logistic regression analysis of delayed healing occurring in VLU patients

图1 模型内部验证临床决策曲线和临床影响曲线图注：A为临床决策曲线图，B为临床影响曲线图。

Figure 1 DCA and CIC diagram for model internal validation

图2 模型外部验证临床决策曲线和临床影响曲线图注：A为临床决策曲线，B为临床影响曲线。

Figure 2 DCA and CIC plots for model external validation

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