【摘要】 目的：探讨瘢痕疙瘩患者手术切除联合电子线放疗后复发的影响因素，并建立风险预测模型。方法：选取2021年5月-2023年5月青海大学附属医院收治的336例瘢痕疙瘩患者为研究对象，根据术后复发情况将瘢痕疙瘩患者分为复发组(n=48)与非复发组(n=288)。比较两组患者的基本资料，采用多因素logistic回归模型分析其复发的危险因素，采用R(R4.3.3)软件建立列线图风险预警模型，并验证其预测效能。结果：复发组与非复发组的瘢痕部位、病灶最大直径、伤口感染史、POSAS评分、生物有效剂量比较差异有统计学意义(P<0.05)；多因素Logistic回归分析结果显示，高张力部位、病灶最大直径≥2 cm、有伤口感染史、高POSAS评分为瘢痕疙瘩患者手术切除联合电子线放疗后复发的危险因素，生物有效剂量为保护因素(P<0.05)；基于以上影响因素构建列线图模型，其一致性指数(C-index)为0.901(95%CI：0.886～0.947)；校正曲线表明，模型的预测结果与实际观察结果基本吻合；ROC曲线下面积(AUC)为0.806(95%CI：0.741～0.871)；决策曲线显示，阈值概率为26%～97%时，模型的净获益较高。结论：瘢痕疙瘩患者手术切除联合电子线放疗后复发与高张力部位、病灶最大直径≥2 cm、有伤口感染史、高POSAS评分及生物有效剂量有关，以此构建的列线图模型具有较高的预测价值，有助于临床识别高危人群。更多还原

【Abstract】 Objective To investigate the factors influencing the recurrence of keloid patients after surgical resection combined with electron radiation therapy,and to establish a risk prediction model.Methods 336 patients with keloid treated in the Affiliated Hospital of Qinghai University from May 2021 to May 2023 were selected as the study objects.According to postoperative recurrence,the patients with keloid were divided into recurrent group (n=48) and non-recurrent group (n=288).The basic data of the two groups were compared,and the risk factors of recurrence were analyzed by multivariate logistic regression model.The risk warning model based on nomogram was established by using R(R4.3.3) software,and its predictive efficacy was verified.Results There were significant differences in scar site,maximum lesion diameter,wound infection history,POSAS score and bioeffective dose between the recurrence group and the non-recurrence group (P<0.05).Multivariate Logistic regression analysis showed that high tension site,maximum lesion diameter ≥2 cm,history of wound infection,and high POSAS score were risk factors for recurrence of keloid patients after surgical resection combined with electron radiation therapy,and biological effective dose was protective factor (P<0.05).Based on the above factors,the consistency index (C-index) was 0.901(95%CI:0.886-0.947).The calibration curve shows that the predicted results of the model are in good agreement with the observed results.The area under ROC curve (AUC) was 0.806(95%CI:0.741-0.871).The decision curve shows that the net benefit of the model is higher when the threshold probability is 26%-97%.Conclusion The recurrence of keloid patients after surgical resection combined with electron radiotherapy is related to high tension site,maximum lesion diameter ≥2 cm,history of wound infection,high POSAS score and bioeffective dose.The nomogram model constructed by this method has high predictive value and is helpful for clinical identification of high-risk groups.更多还原