三叉神经痛微血管减压术后复发危险因素分析及其预后预测模型的建立  

Analysis of risk factors for recurrence of trigeminal neuralgia after microvascular decompression and establishment of prognostic prediction model

作　　者：阿卜力克木·阿卜杜杰力力 姜磊[1] 法吾丹·阿布都 娜尔给扎·艾尔肯 哈力木热提·帕尔哈提 买买提江·卡斯木[1] Abulikemu ABUDUJIELILI;Jiang Lei;Fawudan ABUDU(Four Departments of Neurosurgery Center of the first affiliated hos-pital of Xinjiang medical university,830000,Urumqi,China)

机构地区：[1]新疆医科大学第一附属医院神经外四科,乌鲁木齐830000

出　　处：《立体定向和功能性神经外科杂志》2020年第6期336-341,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨微血管减压术后三叉神经痛的复发危险因素,并据此构建预后预测模型。方法单中心、回顾性地分析349例在新疆医科大学第一附属医院神经外科行微血管减压术的三叉神经痛患者,比较术后未复发组及复发组的临床资料,用logistic回归分析术后复发的危险因素,并用R-Stodio绘制列线图和校准图来建立预测模型。结果 349例研究对象中复发组33例,未复发组316例。两组数据相比较,女性(OR:2.214;95%CI:1.021~4.804;P=0.044)、年龄≤61岁(OR:5.615;95%CI:2.236~14.097;P=0.000)、病程≤2.5年(OR:0.379;95%CI:0.156~0.919;P=0.032)、BNI评分IV分(OR:2.677;95%CI:1.230~5.828;P=0.013),BNI评分V分(OR:3.486;95%CI:1.356~7.286;P=0.000),压迫血管:静脉(OR:4.904;95%CI:1.815~13.250;P=0.002),动静脉合并(OR:5.313;95%CI:1.569~17.984;P=0.007),疼痛分支:上颌支(OR:1.101;95%CI:1.020~1.510;P=0.006),上、下颌支(OR:1.130;95%CI:1.027~1.635;P=0.012)等差异有统计学意义(P<0.05);预测模型预测能力0.8195(95%CI:0.7427~0.8963;P<0.0001)。结论年龄≤61岁,病程≤2.5年,疼痛评分IV~V分,责任血管为岩静脉、或动静脉并发,疼痛分支为上合支或上、下颌支并发为术后复发的危险因素。预测模型准确性高,可个体化预测复发风险率,筛出高危人群,指导临床实践。Objective To explore the risk factors for the recurrence of trigeminal neuralgia after microvascular decompression, and construct a prognostic model based on this.Methods A single-center, retrospective analysis of 349 patients with trigeminal neuralgia who underwent microvascular decompression in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University, and compared the clinical results of the control group(316 cases without recurrence after surgery) and the recurrence group(33 cases) Data, and use logistic regression analysis to explore the risk factors for postoperative recurrence, and use R-Stodio to draw nomograms and calibration charts to establish a prognostic prediction model.Results Among the 349 subjects, 33 were in the recurrence group and 316 were in the non-recurrence group.Comparing the data of the two groups, female(OR:2.214;95%CI:1.02~4.804;P=0.044),age≤61 years(OR:5.615;95%CI:2.236-14.097;P=0.000),course of disease≤2.5 Years(OR:0.379;95%CI:0.156 to 0.919;P=0.032),BNI score IV(OR:2.677;95%CI:1.230~5.828;P=0.013),BNI score V(OR:3.486;95%CI:1.356~7.286;P=0.000),compression of blood vessels: veins(OR:4.904;95%CI:1.815~13.250;P=0.002),combined arteries and veins(OR:5.313;95%CI:1.569~17.984;P=0.007),pain branches: maxillary branch(OR:1.101;95%CI:1.020~1.510;P=0.006),upper and mandibular branch(OR:1.130;95%CI:1.027~1.635;P=0.012) The difference is statistically significant(P<0.05);the predictive ability of the prediction model is 0.8195(95%CI:0.7427~0.8963;P<0.0001).Conclusion Age ≤61 years old, course of disease ≤2.5 years, pain score IV~V,the responsible vessel is petrosal vein, or arteriovenous complications, and the branch of pain is the superior commissural branch or the upper and mandibular branches as a risk factor for postoperative recurrence.The prediction model has high accuracy, can predict the risk of recurrence individually, screen out high-risk groups, and guide clinical practice.

关 键 词：三叉神经痛 微血管减压 危险因素 预后预测 

分 类 号：R745.11[医药卫生—神经病学与精神病学]