基于列线图可视化评估结肠镜肠道准备充分度的研究

Assessment of adequacy of colonoscopic bowel preparation based on nomogram visualization

摘要:

目的 探讨结肠镜检查前根据肠道准备情况建立列线图，评价肠道准备充分度并指导临床决策的可行性。方法 选取2020年9月—2021年3月在中南大学湘雅医院消化内镜中心行结肠镜诊疗的受检者，进行问卷调查，最终回收有效问卷1 023份，问卷内容主要包括受检者的临床特征、排便习惯、服药后排便次数和末次排便时间及检查前肠道准备自评结果，采用单盲法并指定同一位内镜医师对受检者肠道准备情况进行波士顿肠道准备量表（Boston bowel preparation scale，BBPS）评分，运用多因素分析探究肠道准备充分度的影响因素，根据影响因素绘制列线图，评估肠道准备充分度。结果 根据BBPS评分，674例受检者肠道准备充分，349例受检者肠道准备不充分。多因素分析发现每周排便次数（OR=1.649，95%CI：1.233~2.204，P=0.001）、服药后排便次数（OR=3.963，95%CI：1.851~8.485，P<0.001）、服药后末次排便时间（OR=5.151，95%CI：1.152~23.037，P=0.032）、检查前肠道准备自我评估（OR=8.284，95%CI：2.042~33.601，P=0.003）为结肠镜肠道准备充分度的影响因素。根据影响因素绘制列线图可视化评估结肠镜肠道准备充分度，在选择内部验证队列下的受试者工作特征曲线下面积为0.913，最佳截断值为0.824，敏感度为0.746，特异度为0.971。结论 基于每周排便次数、服药后排便次数、服药后末次排便时间、检查前肠道准备自我评估绘制的列线图对结肠镜检查前肠道准备充分度有较好的评估作用，值得推广。

Abstract:

Objective To establish a nomogram to evaluate the adequacy of bowel preparation before colonoscopy and to guide clinical decision-making. Methods A total of 1 023 valid questionnaires from subjects who underwent diagnosis and treatment of colonoscopy at the digestive endoscopy center, Xiangya Hospital, Central South University from September 2020 to March 2021 were finally returned. The contents of the questionnaire mainly included the clinical characteristics, defecation habits, the number of defecation and the time of the last defecation after taking the medicine and the self-assessment results of bowel preparation before colonoscopy. Subjects'' bowel preparation was graded with the Boston bowel preparation scale (BBPS) by a designated endoscopist in a single blinded method. Multivariate analyse was used to explore the influencing factors for bowel preparation adequacy, and a nomogram was drawn accordingly. Results Based on BBPS scores, bowel preparation of 674 subjects were adequate and 349 were inadequate. Multivariate analyse identified the number of defecation per week (OR=1.649,95%CI:1.233-2.204, P=0.001), the number of defecation after medication (OR=3.963, 95%CI: 1.851-8.485, P<0.001), the time of the last defecation after medication (OR=5.151, 95%CI: 1.152-23.037, P=0.032), and self-assessment of bowel preparation before examination (OR=8.284, 95%CI: 2.042-33.601, P=0.003) were influencing factors for the adequacy of bowel preparation for colonoscopy. The area under the receiver operating characteristic curve of assessment of colonoscopic bowel preparation adequacy with nomogram visualization according to influencing factors was 0.913, optimal cutoff value was 0.824, the sensitivity was 0.746, and the specificity was 0.971 under the internal validation cohort. Conclusion The nomogram based on the number of defecation per week, the number of defecation after medication, the time of the last defecation after medication, and self-assessment of bowel preparation before examination could evaluate the adequacy of bowel preparation before colonoscopy, which is worthy of application.