| 高宇光,脱广鑫,马新生,等.尿道下裂术后尿路感染风险预测模型的构建与验证[J].安徽医药,2025,29(9):1787-1791. |
| 尿道下裂术后尿路感染风险预测模型的构建与验证 |
| Construction and validation of a risk prediction model for urinary tract infection after hypospadias surgery |
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| DOI：10.3969/j.issn.1009-6469.2025.09.018 |
| 中文关键词: 尿路感染 尿道下裂 手术后并发症 尿道缺损 预测模型 |
| 英文关键词: Urinary tract infection Hypospadias Postoperative complications Urethral defect Prediction model |
| 基金项目:河北省卫生健康委员会课题( 20240453) |
| 作者 | 单位 | E-mail | | 高宇光 | 邯郸市中心医院小儿外科,河北邯郸,056001 | | | 脱广鑫 | 河北省儿童医院小儿泌尿外科,河北石家庄 050030 | | | 马新生 | 邯郸市中心医院小儿外科,河北邯郸,056001 | | | 李静涛 | 邯郸市中心医院小儿外科,河北邯郸,056001 | | | 魏建新 | 邯郸市中心医院小儿外科,河北邯郸,056001 | | | 马晓楠 | 邯郸市中心医院小儿外科,河北邯郸,056001 | | | 郎兴 | 邯郸市中心医院小儿外科,河北邯郸,056001 | langlangxing@163.com |
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| 中文摘要: |
| 目的探讨尿道下裂术后尿路感染的影响因素，构建预测尿道下裂术后尿路感染风险的列线图模型。方法回顾性选取 2015年 1月至 2023年 4月邯郸市中心医院收治的 1 137例尿道下裂病人为研究对象，按照 7∶3随机分配为建模组( n=796)及验证组( n=341)。随访所有病人术后 6个月内并发症发生情况，并根据建模组病人术后是否出现尿路感染分为尿路感染组(n= 31)和无尿路感染组( n=765)。采用多因素 logistic回归模型分析尿道下裂术后尿路感染的影响因素；构建预测尿道下裂术后尿路感染的列线图模型，并用受试者操作特征曲线( ROC曲线)和校准曲线对列线图模型预测尿道下裂术后尿路感染的区分度和一致性进行验证。结果建模组和验证组、尿道缺损长度、年龄、尿道下裂类型、手术方式及术后近期、远期并发症发生率等方面比较差异无统计学意义( P>0.05)；与无尿路感染组病人相比，尿路感染组病人尿道缺损长度［( 21.34±4.41)mm比(17.35±3.23)mm］、年龄 >2岁( 70.97%比 43.14%)、阴茎阴囊型 /会阴型( 64.52%比 31.90%)及中度 /重度阴茎弯曲的占( 87.10%比 63.01%)比明显升高( P<0.05)；多因素 logistic回归分析结果显示，尿道缺损长度、年龄、尿道下裂类型是尿道下裂术后尿路感染的影响因素( OR=1.44、3.24、3.47，P<0.05)。列线图模型预测尿道下裂术后尿路感染的 ROC曲线下面积为 0.81，95%CI:(0.72，0.89)Hosmer-Lemeshow拟合优度检验 χ2=5.67，P=0.684；验证组预测尿道下裂术后尿路感染的 ROC曲线下面积为 0.86，95%CI:(0.77，0，.94)，Hosmer-Lemeshow拟合优度检验 χ2=7.05，P=0.531。结论尿道缺损长度、年龄、尿道下裂类型是尿道下裂术后尿路感染的影响因素，基于构建的预测尿道下裂术后尿路感染的列线图模型具有较高的区分度和一致性。 |
| 英文摘要: |
| Objective To explore the influencing factors of postoperative urinary tract infection in patients with hypospadias, and toconstruct a nomogram model to predict the risk of urinary tract infection after hypospadias surgery.Methods A total of 1 137 patientswith hypospadias admitted to Handan Central Hospital from January 2015 to April 2023 were retrospectively selected as the study ob-jects, and randomly assigned to the modeling group (n=796) and validation group (n=341) according to 7∶3. All patients were followedup for the incidence of complications within 6 months after surgery, and the patients in the modeling group were separated into a uri-nary tract infection group (n=31) and a non urinary tract infection group (n=765) based on the presence of urinary tract infection aftersurgery. Multivariate logistic regression model was applied to analyze the influencing factors for urinary tract infection after hypospadi-as surgery; a nomogram model was constructed to predict urinary tract infection after hypospadias surgery, ROC curve and calibrationcurve were applied to verify the discrimination and consistency of the nomogram model in predicting postoperative urinary tract infec-tion in patients with hypospadias.Results There was no statistically significant difference between the modeling group and the valida-tion group in terms of urethral defect length, age, type of hypospadias, surgical method, and incidences of short-term and long-term post-operative complications (P>0.05). Compared with the group without urinary tract infection, the proportions of urethral defect length [(21.34±4.41) mm vs. (17.35±3.23) mm], age>2 years old (70.97% vs. 43.14%), penile scrotal/perineal type (64.52% vs. 31.90%), and moderate/severe penile curvature (87.10% vs. 63.01%) in the urinary tract infection group were obviously higher (P<0.05). The resultsof multivariate logistic regression analysis showed that the length of urethral defect, age, and type of hypospadias were the influencing factors for postoperative urinary tract infection (OR=1.44, 3.24, 3.47, respectively; P<0.05). The area under the ROC curve predictedby the nomogram model for postoperative urinary tract infection in hypospadias was 0.81, 95%CI: (0.72,0.89), with a Hosmer-Leme-show goodness of fit test of χ2=5.67 and P=0.684. The area under the ROC curve predicted by the validation group for postoperative uri-nary tract infection after hypospadias surgery was 0.86, 95%CI:(0.77,0.94), with a Hosmer-Lemeshow goodness of fit test of χ2=7.05 and P=0.531.Conclusions The length of urethral defect, age, and type of hypospadias are the influencing factors for urinary tract in-fection after hypospadias surgery. The constructed nomogram model for predicting urinary tract infection after hypospadias surgery hashigh discrimination and consistency. |
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