预测面肌痉挛微血管减压术后迟发性面瘫发生风险列线图的建立及评价  

Establishment and Evaluation of a Nomogram for Predicting the Occurrence of Delayed Facial Palsy after Microvascular Decompression for Hemifacial Spasm

作　　者：王佳明[1] 田雨 冯兆海[1] 王西宪[1] 石鑫[1] 姜磊[1] 郝玉军[1] WANG Jiaming;TIAN Yu;FENG Zhaohai;WANG Xixian;SHI Xin;JIANG Lei;HAO Yujun(Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科中心,乌鲁木齐830054

出　　处：《神经损伤与功能重建》2023年第7期387-390,408,共5页Neural Injury and Functional Reconstruction

摘　　要：目的:评估微血管减压术(microvasculardecompression,MVD)治疗面肌痉挛(hemifacialspasm,HFS)后迟发性面瘫(delayedfacialpalsy,DFP)的发生率,确定对DFP发生最重要的影响因素,并建立DFP发生的预测模型。方法:2015年9月至2020年6月,我院共收治HFS并行MVD术的HFS患者400例。出现DFP 48例(12%),收集患者的临床资料,应用LASSO-Logistic回归分析建立一个预测模型。使用C指数、ROC(受试者工作曲线)、calibration校正曲线来评估预测模型的鉴别、校准和预测性能。结果:预测列线图中包含的预测因素包括年龄、性别、有无面神经压迹、症状侧别、高血压和糖尿病。对模型进行内部验证发现,C指数为0.869(95%CI0.805~0.933),说明模型具有良好的区分度;建模组和验证组的校准曲线与标准曲线均极为接近,具有良好的校准度。结论:高血压和面神经压迹可能是MVD术后发生DFP的危险因素。基于列线图的MVD术后DFP发生风险决策模型具有良好的区分度和准确度。Objective:To investigate the incidence of delayed facial palsy(DFP)after microvascular decompression(MVD)for hemifacial spasm(HFS),identify the most important factors affecting the occurrence of DFP,and establish a prediction model for DFP occurrence.Methods:A total of 400 patients with HFS were admitted to our hospital and underwent MVD between September 2015 and June 2020.Among them,48 patients(12%)developed DFP.The clinical data of the patients were collected,and a prediction model was established by LASSO-Logistic regression analysis.The discrimination,calibration,and predictive performance of the prediction model were assessed using C index,receiver operating characteristic(ROC)curve,and calibration curve.Results:The predictive factors in the prediction nomogram included age,sex,presence of facial nerve pressure trace,symptom laterality,hypertension,and diabetes mellitus.Internal validation of the model revealed a C index of 0.869(95%CI 0.805~0.933),indicating good discrimination of the model;the calibration curves of both the modeling and validation groups were extremely close to the standard curves,indicating good calibration performance.Conclusion:Hypertension and facial nerve pressure trace may be risk factors for the occurrence of DFP after MVD.The nomogram-based risk prediction model of DFP after MVD has good discrimination and accuracy.

关 键 词：迟发性面瘫 风险预测模型 列线图 模型验证 

分 类 号：R741[医药卫生—神经病学与精神病学] R745.12[医药卫生—临床医学]