基于Wilson-Cleary模式构建鼻内镜术后患者健康相关生活质量列线图预测模型

任艳丽; 邹起瑞; 杨利利; 张蒙蒙; 王文忠

doi:10.16766/j.cnki.issn.1674-4152.004041

基于Wilson-Cleary模式构建鼻内镜术后患者健康相关生活质量列线图预测模型

doi: 10.16766/j.cnki.issn.1674-4152.004041

1.
淮北市人民医院耳鼻咽喉头颈外科，安徽淮北 235000
2.
蚌埠医科大学第一附属医院耳鼻喉头颈外科，安徽蚌埠 233004

基金项目:

蚌埠医科大学第一附属医院高新技术项目 2020112

安徽省自然科学基金项目 KJ2020A0568

详细信息

通讯作者:
王文忠，E-mail: 13955259093@163.com

中图分类号: R765.4 R765.9
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- 文章访问数: 15
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-12
- 网络出版日期: 2025-09-04

The prediction model of health-related quality of life after nasal endoscopy constructed based on the Wilson-Cleary model

1.
Department of Otolaryngology and Head and Neck Surgery, Huaibei People's Hospital, Huaibei, Anhui 235000, China

摘要

摘要: 目的基于Wilson-Cleary模式分析功能性鼻内镜术(FESS)后患者健康相关生活质量(HRQoL)的影响因素并构建个体化列线图预测模型，为提升患者HRQoL水平提供参考依据。方法选择2022年1月—2023年12月淮北市人民医院耳鼻咽喉头颈外科172例行FESS手术的患者为研究对象，根据出院后1个月HRQoL水平分为高HRQoL组和低HRQoL组。应用logistic回归分析研究患者HRQoL的主要影响因素，通过R软件中rms包构建列线图并进行模型验证。结果病变范围、是否定期复查、抑郁-焦虑-压力自评得分、家庭关怀度得分、疾病感知得分和鼻腔主观症状得分是FESS术后患者HRQoL的主要影响因素(P＜0.05)。Hosmer-Lemeshow拟合优度检验χ²=2.618，P=0.162，说明回归模型拟合良好，ROC曲线下面积为0.933(95% CI：0.886~0.979，P＜0.001)，灵敏度为87.3%，特异度为91.6%，说明模型区分度良好。结论多发鼻窦炎、未定期复查、负性心理、家庭关怀度差、疾病负面感知高及鼻腔主观症状重的FESS术后患者HRQoL偏差，基于Wilson-Cleary模式构建的HRQoL列线图模型具有良好的预测效果，有利于医护人员预测FESS术后患者HRQoL水平。
- Wilson-Cleary模式 /
- 功能性鼻内镜术 /
- 健康相关生活质量 /
- 预测模型 /
- 列线图
Abstract: Objective To analyze the factors affecting health-related quality of life (HRQoL) of patients after functional endoscopic sinus surgery (FESS) based on Wilson-Cleary model, and construct an individualized nomogram prediction model to provide a reference for improving patients'HRQoL level. Methods A total of 172 patients undergoing FESS operation in the Department of Otolaryngology and Head and Neck Surgery of Huaibei People's Hospital from January 2022 to December 2023 were selected as the study objects. According to the HRQoL level one month after discharge, they were divided into high HRQoL group and low HRQoL group. The main influencing factors of HRQoL of patients were analyzed by logistic regression. The nomogram was constructed by rms package in R software and the model was verified. Results Lesion range, regular review, depression-anxiety-stress self-rating score, family caring score, disease perception score and nasal subjective symptom score were the main influencing factors of HRQoL in patients after FESS (P < 0.05). Hosmer-Lemeshow goodness of fit test were χ²=2.618, P=0.162, indicating that the regression model was well fitted. The area under ROC curve was 0.933 (95% CI: 0.886-0.979, P < 0.001), the sensitivity was 87.3%, and the specificity was 91.6%, indicating that the model was well distinguished. Conclusion The HRQoL of FESS postoperative patients with chronic sinusitis, irregular follow-up review, negative psychology, poor family care, high negative illness perception, and severe subjective nasal symptoms is relatively poor. The HRQoL nomogram model constructed based on Wilson-Cleary model has a good predictive effect, which is helpful for medical staff to predict the HRQoL level of patients after FESS.
- Wilson-Cleary model /
- Functional nasal endoscopy /
- Health-related quality of life /
- Prediction model /
- Nomograph

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图 1 预测患者HRQoL的列线图模型

Figure 1. Nomogram model for predicting HRQoL in patients

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图 2 列线图模型预测患者HRQoL的校准曲线

Figure 2. Calibration curve of HRQoL predicted by the nomogram model

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图 3 列线图模型预测患者HRQoL的ROC曲线

Figure 3. ROC curve of HRQoL predicted by the nomogram model

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表 1 2组CRS患者一般情况比较

Table 1. Comparison of the general conditions between the two groups of CRS patients

项目	高HRQoL组 (n=117)	低HRQoL组 (n=55)	统计量	P值
年龄(x±s, 岁)	44.90±13.98	50.75±15.58	2.466^a	0.015
性别[例(%)]			2.736^b	0.098
男性	71(60.68)	26(47.27)
女性	46(39.32)	29(52.73)
学历[例(%)]			1.073^c	0.283
初中及以下	30(25.64)	21(38.18)
高中/中专/技校	57(48.72)	20(36.36)
大专及以上	30(25.64)	14(25.45)
婚姻状态[例(%)]			0.367^b	0.544
在婚	98(83.76)	44(80.00)
离异/丧偶/未婚	19(16.24)	11(20.00)
家庭年收入[例(%)]			0.978^c	0.328
＜5万元/年	37(31.62)	12(21.82)
5~10万元/年	61(52.14)	34(61.82)
＞10万元/年	19(16.24)	9(16.36)
居住地[例(%)]			2.161^b	0.339
城市	51(43.59)	18(32.73)
乡镇	18(15.38)	12(21.82)
农村	48(41.03)	25(45.45)
病程[例(%)]			0.276^c	0.783
＜1年	41(35.04)	16(29.09)
1~3年	41(35.04)	24(43.64)
＞3年	35(29.92)	15(27.27)
哮喘史[例(%)]			6.087^b	0.014
无	64(54.70)	19(34.55)
有	53(45.30)	36(65.45)
变应性鼻炎史[例(%)]			6.802^b	0.009
无	61(52.14)	17(30.91)
有	56(47.86)	38(69.09)
鼻腔鼻窦手术次数[例(%)]			5.933^b	0.015
1次	111(94.87)	46(83.64)
≥2次	6(5.13)	9(16.36)
病变范围[例(%)]			5.453^b	0.020
单纯性鼻窦炎	67(57.26)	21(38.18)
多发性鼻窦炎	50(42.74)	34(61.82)
BMI(x±s)	22.22±1.84	22.56±1.75	1.153^a	0.251
吸烟嗜好[例(%)]			0.056^b	0.812
无	85(72.65)	39(70.91)
有	32(27.35)	16(29.09)
饮酒嗜好[例(%)]			0.513^b	0.474
无	81(69.23)	41(74.55)
有	36(30.77)	14(25.45)
是否定期复查[例(%)]			16.562^b	＜0.001
否	40(34.19)	37(67.27)
是	77(65.81)	18(32.73)
DASS-21得分(x±s, 分)	47.38±7.86	55.55±8.72	6.130^a	＜0.001
APGAR得分(x±s, 分)	7.52±1.60	6.36±1.64	4.392^a	＜0.001
BIPQ得分(x±s, 分)	41.91±10.35	54.91±10.21	7.717^a	＜0.001
VAS得分(x±s, 分)	2.62±1.20	3.65±1.06	5.445^a	＜0.001
注：^a为t值，^b为χ²值, ^c为Z值。

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表 2 自变量赋值情况

Table 2. Variables assignments

变量	赋值方法
年龄	连续变量，以实际值赋值
哮喘史	有=1，无=2
变应性鼻炎史	有=1，无=2
鼻腔鼻窦手术次数	1次=1，≥2次=2
病变范围	单纯性鼻窦炎=1，多发性鼻窦炎=2
是否定期复查	是=1，否=2
DASS-21得分	连续变量，以实际值赋值
APGAR得分	连续变量，以实际值赋值
BIPQ得分	连续变量，以实际值赋值
VAS得分	连续变量，以实际值赋值

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表 3 患者HRQoL影响因素的logistic回归分析

Table 3. Logistic regression analysis of influencing factors of HRQoL in patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.035	0.019	3.353	0.067	1.035	0.998~1.075
哮喘史	0.908	0.601	2.281	0.131	2.479	0.763~8.055
变应性鼻炎史	0.611	0.596	1.052	0.305	1.843	0.573~5.925
鼻腔鼻窦手术次数	1.264	0.989	1.633	0.201	3.539	0.509~24.585
病变范围	1.612	0.610	6.984	0.008	5.012	1.517~16.564
是否定期复查	-1.295	0.586	4.886	0.027	0.274	0.087~0.864
DASS-21得分	0.103	0.039	7.073	0.008	1.108	1.027~1.195
APGAR得分	-0.500	0.175	8.200	0.004	0.607	0.431~0.854
BIPQ得分	0.136	0.030	20.705	＜0.001	1.146	1.080~1.215
VAS得分	0.956	0.271	12.424	＜0.001	2.602	1.529~4.428

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