| 张洋,刘晓君,郝培培,等.微波消融术治疗甲状腺良性结节疗效影响因素的 logistic回归模型及预测价值评价[J].安徽医药,2023,27(7):1417-1421. |
| 微波消融术治疗甲状腺良性结节疗效影响因素的 logistic回归模型及预测价值评价 |
| Logistic regression model and predictive value evaluation of factors influencing the efficacy of microwave ablation in the treatment of benign thyroid nodules |
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| DOI：10.3969/j.issn.1009-6469.2023.07.032 |
| 中文关键词: 甲状腺结节 微波消融术 治疗效果 影响因素 logistic回归模型 预测价值 |
| 英文关键词: Thyroid nodule Microwave ablation Treatment outcome Influencing factors Logistic regression model Predictive value |
| 基金项目:2020年度河北省医学科研课题计划( 20200432) |
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| 中文摘要: |
| 目的探究微波消融术治疗甲状腺良性结节疗效影响因素的 logistic回归模型及预测价值。方法选取华北医疗健康集团峰峰总医院 2018年 5月至 2021年 1月甲状腺良性结节病人 171例作为研究对象，均行微波消融术治疗，以术后 12个月作为随访终点，根据结节缩小率( VRR)分为有效组( VRR≥50%)与未无效组( VRR<50%)。收集两组临床资料，采用 logistic回归模型分析微波消融术治疗甲状腺良性结节疗效影响因素，并评价其预测价值。结果单因素分析，结节长径、结节体积、增强模式、合并肝损伤、合并肾损伤是微波消融术治疗甲状腺良性结节疗效的影响因素(P<0.05)；无效组游离甲状腺素(FT4)、总甲状腺素(TT4)水平( 72.58±13.92)pmol/L、(10.63±3.08)pmol/L低于有效组(88.84±17.36)pmol/L、(15.16±5.05)pmol/L，促甲状腺激素( TSH)水平( 2.72±0.90)pmol/L高于有效组( 1.83±0.61)pmol/L；构建 logistic回归模型显示，结节长径 >2 cm、结节体积 >5 mL、TSH、结节内部成分囊性为主是微波消融术治疗甲状腺良性结节疗效的独立危险因素，高增强模式、 FT4、TT4是微波消融术治疗甲状腺良性结节疗效的独立保护因素( P<0.05)；似然比检验显示 logistic回归模型构建差异有统计学意义； Waldχ2检验显示 logistic回归模型构建有效；霍斯默 ·莱梅肖( Hosmer-Lemeshow)拟合优度检验显示 logistic回归模型拟合效果较好； ROC曲线分析， logistic回归模型预测微波消融术治疗甲状腺良性结节疗效的 AUC 95%CI为 0.91(0.85，0.97)灵敏度为 80.65%，特异度为 90.00%。结论微波消融术治疗甲状腺良性结节疗效的影响因素较多，构建 logistic回归模型具有可，靠预测价值，能为临床及早预测疗效、合理制定与调整治疗方案提供有效依据。 |
| 英文摘要: |
| Objective To investigate the logistic regression model and predictive value of factors influencing the efficacy of microwave ablation for benign thyroid nodules.Methods One hundred and seventy-one patients with benign thyroid nodules from May 2018to January 2021 in Fengfeng General Hospital of North China Medical and Health Group were selected as study subjects, all of whomwere treated with microwave ablation, and 12 months after surgery was used as the follow-up endpoint, and the patients were divided into effective group (VSR ≥ 50 %) and non-effective group (VSR < 50 %) according to the nodule reduction rate (VSR). The clinical dataof the two groups were collected, and the factors influencing the efficacy of microwave ablation for benign thyroid nodules were analyzed using logistic regression models, and their predictive value was evaluated.Results In univariate analysis, nodule length, nodulevolume, enhancement pattern, combined liver injury, and combined kidney injury were factors affecting the efficacy of microwave ablation for benign thyroid nodules (P < 0.05); free thyroxine (FT4) and total thyroxine (TT4) levels (72.58 ± 13.92) pmol/L, (10.63 ± 3.08)pmol/L in the ineffective group (88.84±17.36) pmol/L, (15.16±5.05) pmol/L, and thyrotropin (TSH) levels (2.72±0.90) pmol/L were higher than those in the effective group (1.83±0.61) pmol/L. The logistic regression model showed that nodule length > 2 cm, nodule volume > 5 mL, TSH, and nodule internal component cystic were independent risk factors for the efficacy of microwave ablation for benignthyroid nodules, and high enhancement mode, FT4, and TT4 were independent protective factors for the efficacy of microwave ablationfor benign thyroid nodules (P < 0.05); the likelihood ratio test showed that the difference of logistic regression model construction wasstatistically significant; The Wald test showed that the logistic regression model was valid; the Hosmer-Lemeshow goodness-of-fit test showed that the logistic regression model was a good fit; the ROC curve analysis showed that the logistic regression model predicted theefficacy of microwave ablation for benign thyroid nodules with an AUC 95%CI of 0.91(0.85, 0.97 ), with a sensitivity of 80.65% and specificity of 90.00 %.Conclusion There are many factors influencing the efficacy of microwave ablation for benign thyroid nodules,and the construction of logistic regression model has reliable predictive value, which can provide an effective basis for clinical early prediction of efficacy and reasonable formulation and adjustment of treatment plan. |
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