浙江医学2025，Vol.47Issue(17)：1818-1823,1829,7.DOI:10.12056/j.issn.1006-2785.2025.47.17.2024-2601
绝经后宫颈环形电切术后宫颈粘连发生风险的列线图预测模型构建与评估
Construction and evaluation of a nomogram prediction model for the risk of cervical adhesion in menopausal patients after LEEP surgery
摘要
Abstract
Objective To construct and evaluate the application performance of a nomogram prediction model for the risk of cervical adhesion in menopausal patients undergoing loop electrosurgical excision procedure(LEEP).Methods From November 2023 to April 2024,clinical data of 216 menopausal patients who underwent LEEP surgery in Hengshui People's Hospital were retrospectively collected,and patients were divided into an occurrence group(n=86)and a non-occurrence group(n=130)based on the presence or absence of cervical adhesions.Logistic regression analysis was used to screen risk factors for cervical adhesions after menopausal LEEP surgery.R software was applied to draw the nomogram,and receiver operating characteristic(ROC)curves,calibration curves,Hosmer-Lemeshow goodness of fit tests,and decision curve were used to evaluate the model performance.Results Among the 216 menopausal patients who underwent LEEP surgery in Hengshui People's Hospital,a total of 86(39.81％)cases developed cervical adhesions.There was no statistically obvious difference between the occurrence group of cervical adhesion in menopausal patients after LEEP surgery and the non-occurrence group in terms of different body mass index classification,marital status,per capita monthly income of families,medical expense payment method,hypertension,diabetes,hyperlipidemia,resection thickness,and LEEP time(all P＞0.05).Statistically significant differences were observed between the two groups in age,pregnancy times,cesarean section history,intraoperative bleeding,resection depth,urinary catheter,and postoperative infection(all P＜0.05).Logistic regression analysis showed that pregnancy of"≥2 times"(OR=8.970,95％CI:3.910-20.577),intraoperative blood loss of"＞20 mL"(OR=12.755,95％CI:4.840-33.611),resection depth of"＞15 mm"(OR=7.672,95％CI:3.458-17.024),and postoperative infection(OR=6.759,95％CI:2.582-17.692)were independent risk factors for cervical adhesion in menopausal patients after LEEP surgery(all P＜0.001).The AUC of the nomogram in predicting cervical adhesion of menopausal patients after LEEP surgery was 0.814(95％CI:0.755-0.873).The slope of the calibration curve was close to 1,and the Hosmer-Lemeshow goodness of fit test showed x2=6.014,P=0.422.Taking P(prediction probability)＞0.392(critical value)as the prediction standard,the predictive sensitivity and specificity of the nomogram for predicting cervical adhesion after LEEP in postmenopausal women were 0.605 and 0.915,respectively.Decision curve analysis showed that there was a clinical benefit advantage when the threshold probability was between 0.12 and 0.97.Conclusion Pregnancy of"≥2 times",intraoperative blood loss of"＞20 mL",resection depth of"＞15 mm",and postoperative infection are independent risk factors for cervical adhesion in menopausal patients post-LEEP surgery.The nomogram constructed by combining these four indicators can predict the risk of cervical adhesion in menopausal patients after LEEP surgery in an individualized manner.关键词
绝经/宫颈环形电切术/宫颈粘连/风险/列线图预测模型/构建/评估Key words
Menopause/Loop electrosurgical excision procedure/Cervical adhesion/Risk/Nomogram prediction model/Construction/Evaluation引用本文复制引用
陈欢,林萍,王静,张春丽,赵宁..绝经后宫颈环形电切术后宫颈粘连发生风险的列线图预测模型构建与评估[J].浙江医学,2025,47(17):1818-1823,1829,7.基金项目
衡水市科技计划项目(2021014095Z) （2021014095Z）
