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上尿路草酸钙结石湿热证诊断模型的开发与验证
周映霖,胡磊,周建甫,王崇奕,甘澍,王树声,向松涛
广州中医药大学第二临床医学院广州 510405;广州中医药大学第二附属医院泌尿外科广州 510370;广州中医药大学第一附属医院泌尿外科广州 510405
摘要:
目的:基于上尿路草酸钙结石湿热证患者,开发一个LASSO-Logistic回归的机器学习模型,以提高上尿路草酸钙结石湿热证的诊断准确性。方法:回顾性收集343例上尿路草酸钙结石湿热证患者的临床数据,依据中医湿热证的诊断标准将患者分为湿热证组267例和非湿热证组76例。使用LASSO-Logistic回归方法筛选湿热证诊断的关键特征,并构建湿热证诊断模型,模型通过Bootstrap法1000次重抽样进行内部验证,并通过Hosmer-Lemeshow检验、受试者工作特征曲线(ROC曲线)和决策曲线评估其性能。结果:LASSO-Logistic回归方法筛选出包括年龄、复发次数、血肌酐及甘油三酯水平4个诊断上尿路草酸钙结石湿热证的指标,用上述4个变量构建的模型显示出高区分度(AUC=0.918),以及良好的敏感性(74.5%)和特异性(92.1%)。结论:本研究开发的诊断模型能够有效地诊断上尿路草酸钙结石湿热证,有望为上尿路草酸钙结石湿热证的中西医结合诊治提供一种便捷、可靠的诊断工具。
关键词:  上尿路草酸钙结石  湿热证  LASSO-Logistic回归  机器学习  诊断模型
DOI:10.3969/j.issn.1007-6948.2025.06.003
投稿时间:2025-04-21
基金项目:广州地区中西医协同临床重大创新技术建设项目(穗卫函〔2023〕2318号);广东省中医药局面上项目(20221170)
Development and validation of a diagnostic model for damp-heat syndrome in upper urinary tract calcium oxalate stones
ZHOU Ying-lin,HU Lei,ZHOU Jian-fu
Abstract:
Objective To develop a machine learning model based on LASSO-Logistic regression to improve the diagnostic accuracy of damp-heat syndrome in patients with upper urinary tract calcium oxalate stones. Methods Clinical data from 343 patients with upper urinary tract calcium oxalate stones were retrospectively collected, and patients were divided into damp-heat syndrome group (n=267) and non-damp-heat syndrome group (n=76) according to traditional Chinese medicine diagnostic criteria. The LASSO-Logistic regression method was used to select key diagnostic features and construct a diagnostic model. The model was internally validated through 1000 bootstrap resamplings and evaluated using the Hosmer-Lemeshow test, receiver operating characteristics curve (ROC curve), and decision curve analysis. Results The LASSO-Logistic regression method identified four features with significant diagnostic value for damp-heat syndrome, including age, recurrence number, serum creatinine, and triglyceride levels. The model demonstrated high discriminative ability (AUC=0.918) and good sensitivity (74.5%) and specificity (92.1%). Conclusion The diagnostic model developed using LASSO-Logistic regression effectively diagnoses damp-heat syndrome in patients with upper urinary tract calcium oxalate stones, providing a novel and reliable diagnostic tool for clinical use. Future research will explore the application and validation of this model in a broader sample and multiple centers.
Key words:  Upper urinary tract calcium oxalate stones  damp-heat syndrome  LASSO-Logistic regression  machine learning  diagnostic model

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