三叉神经痛患者PBC手术效果及影响因素预测模型构建

doi:10.19854/j.cnki.1008-2425.2024.06.0004

摘要/Abstract

摘要： 目的评价三叉神经痛(trigeminal neuralgia TN)患者经皮穿刺三叉神经半月节球囊压迫术(percutaneous balloon compression PBC)手术效果及影响因素,并构建预测模型。方法选取2019年8月至2022年12月收治的156例行PBC手术的TN患者为研究对象。PBC术后随访1年评价疗效。收集患者临床资料,进行单因素分析和多因素logistic回归分析。构建影响TN患者PBC手术效果的预测模型,进行Hosmer-Lemeshow拟合优度检验。采用ROC曲线分析预测模型的灵敏度和特异度。另选取52例PBC手术患者进行临床验证,采用kappa检验分析预测模型与临床实际的一致性。结果最终纳入156例患者。根据患者PBC手术效果分为有效组126例和无效组30例。与有效组比较,无效组患者体质指数≥24 kg/m²、病程≥5年、术后1天NRS疼痛评分≥1分、术中球囊压迫时间＜3 min、术中球囊充盈容量＜1 ml的比例较高,术中球囊形态为梨形的比例较低(P＜0.05)。多因素logistic回归分析显示,术中球囊压迫时间＜3 min(OR=2.959)、术中球囊充盈容量＜1 ml(OR=5.063)、术中球囊形态非梨形(OR=3.469)是导致TN患者PBC手术无效的危险因素(P＜0.05)。预测模型:P=e^x/(1+e^x),X=-2.087+1.085×术中球囊压迫时间+1.622×术中球囊充盈容量+1.244×术中球囊形态。ROC曲线下面积为0.920(95%CI=0.863-0.978,P＜0.001),灵敏度为85.15%,特异度为86.67%。Hosmer-Lemeshow拟合优度检验显示χ²=6.733,P=0.566,提示该回归模型的拟合水平较好。临床验证该预测模型的准确率为82.69%,预测模型与临床实际的一致性检验kappa值为0.532。结论术中球囊压迫时间＜3 min、术中球囊充盈容量＜1 ml、术中球囊形态非梨形是导致TN患者PBC手术无效的独立危险因素。本研究构建的预测模型准确率较高,对临床评估PBC手术效果具有一定的指导意义。

关键词: 三叉神经痛, 影响因素, 预测模型

Abstract: Objective To evaluate the effect of percutaneous balloon compression (PBC) on patients with trigeminal neuralgia (TN) and its influencing factors,and construct a prediction model. Methods A total of 156 patients with TN who underwent PBC between August 2019 and December 2022 were selected as the study subjects.All of them were followed up for 1 year after PBC to evaluate the curative effect.The patients’ clinical data were collected for univariate analysis and multivariate logistic regression analysis.A prediction model for the effect of PBC on patients with TN was constructed and Hosmer-Limeshow goodness of fit test was conducted.The ROC curve was used to analyze the sensitivity and specificity of the prediction model.Other 52 patients undergoing PBC were selected for clinical validation.Kappa test was used to analyze the consistency between the prediction model and clinical practice. Results Finally,156 patients were included.According to the effect of PBC surgery,patients were divided into effective group of 126 cases and ineffective group of 30 cases.Compared with the effective group,the ineffective group with body mass index of ≥ 24 kg/m²,disease course of ≥ 5 years,NRS pain score ≥ 1 point on the 1st day after surgery,intraoperative balloon compression time <3 minutes,and intraoperative balloon filling volume <1 ml was higher,while the intraoperative non-pear-shaped balloon was lower (P＜0.05).Multivariate logistic regression analysis found that intraoperative balloon compression time <3 min (OR=2.959),intraoperative balloon filling capacity <1 ml (OR=5.063) and intraoperative non-pear-shaped balloon (OR=3.469) were risk factors for ineffective PBC surgery in patients with TN (P＜0.05).The prediction model was as follow:P=e^x/(1+e^x),X=-2.087+1.085×intraoperative balloon compression time+1.622×intraoperative balloon filling capacity+1.244×the shape of balloon during operation.The area under the ROC curve was 0.920 (95% CI=0.863-0.978,P＜0.001).The sensitivity and specificity were 85.15% and 86.67%.Hosmer-Lemeshow goodness of fit test showed χ²=6.733,P=0.566,indicating that the regression model has good fit.Clinical validation found that the accuracy of the prediction model was 82.69%,and the Kappa value of consistency test between the prediction model and clinical practice was 0.532. Conclusion The intraoperative balloon compression time <3 min,intraoperative balloon filling capacity <1 ml and intraoperative non-pear-shaped balloon were risk factors for ineffective PBC surgery in patients with TN.The prediction model constructed in this study has high accuracy and is of certain guiding significance for clinical evaluation of the effect of PBC.

Key words: Trigeminal neuralgia, Influencing factor, Prediction model

中图分类号:

R745.5⁺1

陈燕中, 刘宇权, 赖斐然, 刘炯锋, 赖尚导. 三叉神经痛患者PBC手术效果及影响因素预测模型构建[J]. 立体定向和功能性神经外科杂志, 2024, 37(6): 339-345.

Chen Yanzhong, Liu Yuquan, Lai Feiran, Liu Jiongfeng, Lai Shangdao. Effect of PBC on patients with trigeminal neuralgia and its influencing factors and construction of prediction model[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(6): 339-345.

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