目的分析基于Clavien-Dindo分级的腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)术后并发症的相关因素,构建对应的预测模型并验证其效能。方法采用前瞻性研究,选取2023年1月至2025年5月于太仓市第一人民医院行L...目的分析基于Clavien-Dindo分级的腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)术后并发症的相关因素,构建对应的预测模型并验证其效能。方法采用前瞻性研究,选取2023年1月至2025年5月于太仓市第一人民医院行LCBDE的病人285例,以2∶1随机分为训练集、验证集,分别190例、95例。随访统计病人术后并发症Clavien-Dindo分级,将训练集病人中发生Clavien-Dindo分级≥Ⅱ级并发症者分为并发症≥Ⅱ级组,无并发症及Clavien-Dindo分级Ⅰ级并发症者分为并发症0~Ⅰ级组。比较两组一般资料,经多因素logistic回归模型分析ClavienDindo分级≥Ⅱ级并发症的影响因素,建立对应的预测模型,采用受试者操作特征(ROC)曲线、校正曲线验证其效能及区分度。结果并发症≥Ⅱ级组26例,并发症0~Ⅰ级组164例,并发症≥Ⅱ级组美国麻醉医师协会(ASA)分级≥Ⅲ级构成比、合并中/重度急性胆管炎构成比、查尔森合并症指数(Charlson comorbidity index,CCI)、术中出血量均高于并发症0~Ⅰ级组(均P<0.05),白蛋白水平低于并发症0~Ⅰ级组(P<0.05)。多因素logistic回归模型显示,以下因素是LCBDE术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素:ASA分级≥Ⅲ级(OR=3.550,95%CI:1.271~9.915),CCI评分(OR=2.617,95%CI:1.151~5.949),合并中/重度急性胆管炎(OR=2.171,95%CI:1.296~3.635),术中出血量(OR=2.872,95%CI:1.322~6.241),均P<0.05;白蛋白(OR=0.426,95%CI:0.200~0.904)是保护因素(P<0.05);建立logistic回归方程:Logit函数=–12.874–0.854X1(白蛋白)+1.267X2(ASA分级≥Ⅲ级)+0.962X3(CCI评分)+0.775X4(合并中/重度急性胆管炎)+1.055X5(术中出血量)。ROC曲线显示,该模型预测训练集术后发生Clavien-Dindo分级≥Ⅱ级并发症的曲线下面积(AUC)为0.929,敏感度为84.62%,特异度为98.17%,预测验证集术后发生Clavien-Dindo分级≥Ⅱ级并发症的AUC为0.920,敏感度为92.31%,特异度为81.71%。HosmerLemeshow检验显示,该预测模型预测训练集、验证集病人术后发生Clavien-Dindo分级≥Ⅱ级并发症的概率与实际概率比较,差异均无统计学意义(训练集:χ^(2)=6.036,P=0.702;验证集:χ^(2)=7.254,P=0.512)。结论ASA分级≥Ⅲ级、CCI评分、合并中/重度急性胆管炎、术中出血量是LCBDE术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素,白蛋白是保护因素,对应的预测模型经验证具有良好的预测效能。展开更多
In the paper, a general framework for large scale modeling of macroeconomic and financial time series is introduced. The proposed approach is characterized by simplicity of implementation, performing well independentl...In the paper, a general framework for large scale modeling of macroeconomic and financial time series is introduced. The proposed approach is characterized by simplicity of implementation, performing well independently of persistence and heteroskedasticity properties, accounting for common deterministic and stochastic factors. Monte Carlo results strongly support the proposed methodology, validating its use also for relatively small cross-sectional and temporal samples.展开更多
文摘目的分析基于Clavien-Dindo分级的腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)术后并发症的相关因素,构建对应的预测模型并验证其效能。方法采用前瞻性研究,选取2023年1月至2025年5月于太仓市第一人民医院行LCBDE的病人285例,以2∶1随机分为训练集、验证集,分别190例、95例。随访统计病人术后并发症Clavien-Dindo分级,将训练集病人中发生Clavien-Dindo分级≥Ⅱ级并发症者分为并发症≥Ⅱ级组,无并发症及Clavien-Dindo分级Ⅰ级并发症者分为并发症0~Ⅰ级组。比较两组一般资料,经多因素logistic回归模型分析ClavienDindo分级≥Ⅱ级并发症的影响因素,建立对应的预测模型,采用受试者操作特征(ROC)曲线、校正曲线验证其效能及区分度。结果并发症≥Ⅱ级组26例,并发症0~Ⅰ级组164例,并发症≥Ⅱ级组美国麻醉医师协会(ASA)分级≥Ⅲ级构成比、合并中/重度急性胆管炎构成比、查尔森合并症指数(Charlson comorbidity index,CCI)、术中出血量均高于并发症0~Ⅰ级组(均P<0.05),白蛋白水平低于并发症0~Ⅰ级组(P<0.05)。多因素logistic回归模型显示,以下因素是LCBDE术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素:ASA分级≥Ⅲ级(OR=3.550,95%CI:1.271~9.915),CCI评分(OR=2.617,95%CI:1.151~5.949),合并中/重度急性胆管炎(OR=2.171,95%CI:1.296~3.635),术中出血量(OR=2.872,95%CI:1.322~6.241),均P<0.05;白蛋白(OR=0.426,95%CI:0.200~0.904)是保护因素(P<0.05);建立logistic回归方程:Logit函数=–12.874–0.854X1(白蛋白)+1.267X2(ASA分级≥Ⅲ级)+0.962X3(CCI评分)+0.775X4(合并中/重度急性胆管炎)+1.055X5(术中出血量)。ROC曲线显示,该模型预测训练集术后发生Clavien-Dindo分级≥Ⅱ级并发症的曲线下面积(AUC)为0.929,敏感度为84.62%,特异度为98.17%,预测验证集术后发生Clavien-Dindo分级≥Ⅱ级并发症的AUC为0.920,敏感度为92.31%,特异度为81.71%。HosmerLemeshow检验显示,该预测模型预测训练集、验证集病人术后发生Clavien-Dindo分级≥Ⅱ级并发症的概率与实际概率比较,差异均无统计学意义(训练集:χ^(2)=6.036,P=0.702;验证集:χ^(2)=7.254,P=0.512)。结论ASA分级≥Ⅲ级、CCI评分、合并中/重度急性胆管炎、术中出血量是LCBDE术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素,白蛋白是保护因素,对应的预测模型经验证具有良好的预测效能。
文摘In the paper, a general framework for large scale modeling of macroeconomic and financial time series is introduced. The proposed approach is characterized by simplicity of implementation, performing well independently of persistence and heteroskedasticity properties, accounting for common deterministic and stochastic factors. Monte Carlo results strongly support the proposed methodology, validating its use also for relatively small cross-sectional and temporal samples.
