Chinese General Practice ›› 2021, Vol. 24 ›› Issue (30): 3893-3899.DOI: 10.12114/j.issn.1007-9572.2021.00.584

Special Issue: 女性健康最新文章合集

• Monographic Research • Previous Articles     Next Articles

Establishment of a Rothman-Keller-type Risk Prediction Model for Stress Urinary Incontinence in Adult Women Using Evidence-based Data 

  

  1. 1.Department of General Practice,Yangpu Hospital,Tongji University,Shanghai 200090,China
    2.Tongji University,Shanghai 200092,China
    3.Department of General Practice,Tongji University School of Medicine,Shanghai 200090,China
    4.Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China
    5.Clinical Research Center for General Practice,Tongji University,Shanghai 200090,China
    *Corresponding author:YANG Sen,Attending physician;E-mail:ysylq2020@126.com
  • Published:2021-10-20 Online:2021-10-20

循证视角下成年女性压力性尿失禁发病风险的Rothman-Keller模型构建研究

  

  1. 1.200090上海市,同济大学附属杨浦医院全科医学科 2.200092上海市,同济大学 3.200090上海市,同济大学医学院全科医学系 4.200090上海市全科医学与社区卫生发展研究中心 5.200090上海市,同济大学全科医学临床研究中心
    *通信作者:杨森,主治医师;E-mail:ysylq2020@126.com
  • 基金资助:
    上海市扬帆计划(20YF1444900)

Abstract: Background As the most common type of female urinary incontinence,stress urinary incontinence(SUI) has an increasing incidence in adult women with the process of aging and lifestyle changes in recent years. Although it is not life-threatening,it seriously affects the performance of work and physical and mental health. Objective To develop a Rothman-Keller-type model for actively screening for SUI risk in adult women,so as to effectively identify and timely intervene with the high-risk groups. Methods Observational studies about SUI in adult women were searched from databases of PubMed,EMBase,SinoMed,CNKI and Wanfang Data from January 2005 to December 2020. Review Manager 5.3 software was used for meta-analysis. The establishing principles of the Rothman-Keller model were used for creating a Rothman-Keller-type model for predicting the risk of SUI in adult women,and the threshold of different risks was determined using simulation data sets. The predictive accuracy of the model was verified by using Logistic regression model. Results Finally,18 articles were included.The 12 risk factors obtained from analysis were:age(≥50 years),BMI(≥24 kg/m2),menopause,urinary system infection,vaginal delivery,and pelvic prolapse,history of pelvic surgery,number of deliveries(≥3 times),constipation,chronic respiratory disease,hypertension,and diabetes. We generated 20 000 simulated individual data based on the risk factors using binomial distribution function,and incorporated them into the Rothman-Keller-type model to plot a curve predicting the SUI risk in adult women,and chose 0.285 5 and 0.429 4 as the threshold for dividing low and intermediate risks,and intermediate and high risks,respectively,according to the curve changes. We incorporated the simulated individual data into a Logistic regression model to plot a curve predicting the SUI risk in adult women,and used 0.261 2 and 0.547 4 as the threshold for dividing low and intermediate risks,and intermediate and high risks,respectively,according to changes in the curve. Validation results of risk prediction for a 60-year-old female:she was predicted to have a high risk for SUI〔P=0.485 6(>0.429 4)〕 by the Rothman-Keller-type model,and was classified into high risk group for SUI 〔P=0.878 6(>0.547 4)〕 according to the prediction using the Logistic regression model,indicating that the predictive results of the two models were consistent. Conclusion Our model has proved to have strong accuracy and predictability. Our experience may provide ideas for the development of risk prediction models for other chronic diseases.

Key words: Urinary incontinence, stress;Femininity;Meta-analysis;Rothman-Keller model;Forecasting

摘要:

背景 压力性尿失禁(SUI)是最常见的女性尿失禁类型,随着人口老龄化和生活方式的改变,近年来成年女性SUI发病率逐年升高。虽然SUI不会造成生命威胁,但会严重影响女性的日常工作和身心健康。目的 基于循证视角,对成年女性SUI发病风险进行评估及预测,从而有效识别出SUI高危人群,及早进行健康干预。方法 计算机检索PubMed、EMBase、SinoMed、中国知网和万方数据知识服务平台,检索时间限定为2005年1月至2020年12月,筛选关于成年女性发生SUI的观察性研究。采用Review Manager 5.3软件进行Meta分析,运用Rothman-Keller模型原理构建成年女性SUI发病风险评估模型,再通过模拟数据集确定风险评估等级划分界值,最终运用Logistic回归模型进行准确度验证。结果 最终纳入18篇文献进行Meta分析,得到的12项成年女性SUI危险因素分别为年龄(≥50岁)、体质指数(BMI)(≥24 kg/m2)、绝经、泌尿系统感染、阴道分娩、盆腔脱垂、盆腔手术史、分娩次数(≥3次)、便秘、慢性呼吸系统疾病、高血压、糖尿病。根据12项危险因素的二项分布函数模拟生成20 000例数据,代入到构建的Rothman-Keller模型。绘制Rothman-Keller模型预测成年女性SUI发病风险曲线,根据其变化趋势分别选择发病风险为0.285 5、0.429 4作为成年女性SUI的低危、中危、高危划分界值。通过模拟数据集生成Logistic回归模型预测成年女性SUI发病风险曲线,根据其变化趋势分别选择发病风险为0.261 2、0.547 4作为成年女性SUI的低危、中危、高危划分界值。1例60岁女性发病风险预测验证结果:根据Rothman-Keller模型预测该个体SUI发病风险P=0.485 6(>0.429 4),属于高危人群;Logistic回归模型预测该个体SUI发病风险P=0.878 6(>0.547 4),属于高危人群,与Rothman-Keller模型个体风险评估等级划分结果一致。结论 本研究建立的成年女性SUI发病风险Rothman-Keller模型具备较强的准确性及预测性,同时为其他慢性病的发病风险预测模型研究提供了借鉴思路。

关键词: 尿失禁, 压力性;女性;Meta分析;Rothman-Keller模型;预测