摘要
目的分析肺癌患者胸腔镜术后肺部感染的影响因素,并构建风险预测列线图模型。方法选取2022年1月至2024年12月在北京市大兴区人民医院接受胸腔镜手术治疗的204例肺癌患者为研究对象,根据术后是否发生肺部感染分为感染组(39例)和非感染组(165例)。采用单因素及多因素Logistic逐步回归分析肺部感染的影响因素;构建肺癌患者胸腔镜术后肺部感染的列线图模型,并采用受试者工作特性曲线评估其预测价值。结果204例接受胸腔镜手术治疗的肺癌患者中发生肺部感染39例(19.12%),共检出53株病原菌,以革兰阴性菌为主(62.26%)。单因素分析显示,感染组年龄、糖尿病史、TNM临床分期(Ⅲ期)、术中出血量≥200 mL、手术时间≥3 h、机械通气时间≥12 h比例,C反应蛋白水平、白细胞计数高于非感染组,白蛋白水平低于非感染组(P<0.05)。多因素分析显示,年龄大、TNM临床分期(Ⅲ期)、机械通气时间≥12 h、高水平C反应蛋白是肺癌患者术后肺部感染的独立危险因素(P<0.05)。列线图模型预测肺癌患者胸腔镜术后肺部感染的曲线下面积(95%CI)为0.902(0.851~0.953),特异度为68.33%,灵敏度为92.08%。结论基于肺癌患者术后肺部感染危险因素构建的列线图模型具有良好的预测性能,可作为临床风险评估的有效辅助手段。
Objective To analyze the influencing factors of pulmonary infection after thoracoscopic surgery in patients with lung cancer and construct a risk prediction nomogram model.Methods A total of 204 patients with lung cancer who underwent thoracoscopic surgery at Beijing Daxing District People's Hospital from January 2022 to December 2024 were divided into an infection group(n=39)and a non-infection group(n=165)based on whether pulmonary infection occurred after surgery.Univariate and multivariate logistic stepwise regression analyses were used to identify influencing factors of pulmonary infection.A nomogram prediction model for pulmonary infection after thoracoscopic surgery in lung cancer patients was constructed,and its predictive value was evaluated using the receiver operating characteristic(ROC)curve.Results Among the 204 lung cancer patients who underwent thoracoscopic surgery,39 patients(19.12%)developed pulmonary infections,with a total of 53 strains of pathogens detected,predominantly Gram-negative bacteria(62.26%).Univariate analysis showed that the infection group had higher proportions of older age,diabetes history,TNM clinical stageⅢ,intraoperative blood loss≥200 mL,operation time≥3 h,and mechanical ventilation time≥12 h compared to the non-infection group.Additionally,C-reactive protein levels and white blood cell counts were higher,while albumin levels were lower in the infection group(P<0.05).Multivariate analysis showed that older age,TNM clinical stageⅢ,mechanical ventilation time≥12 h,and elevated C-reactive protein levels were independent risk factors for postoperative pulmonary infection(P<0.05).The area under the curve(AUC)(95%CI)of the nomogram model for predicting pulmonary infection was 0.902(0.851-0.953),with a specificity of 68.33%and a sensitivity of 92.08%.Conclusion The nomogram model constructed based on the risk factors of pulmonary infection has good predictive performance and can be used as an effective auxiliary means for clinical risk assessment.
作者
柳建垒
闻作川
王永平
田浩
王辉
LIU Jianlei;WEN Zuochuan;WANG Yongping;TIAN Hao;WANG Hui(Department of Thoracic and Vascular Surgery,Daxing District People's Hospital,Beijing 102600,China)
出处
《转化医学杂志》
2025年第7期132-136,共5页
Translational Medicine Journal
基金
河北省中医药类科研计划项目(2020440)
大兴区人民医院科研课题项目(4202522559)。
关键词
肺癌
胸腔镜手术
肺部感染
危险因素
列线图
Lung cancer
Thoracoscopic surgery
Pulmonary infection
Risk factors
Nomogram
