神经减压术治疗偏头痛患者的疗效影响因素及预测模型构建  

Influencing factors of efficacy of nerve decompression surgery in the treatment of migraine patients and construction of prediction model

作　　者：杨涛[1] 李红伟[2] 王东 YANG Tao;LI Hongwei;WANG Dong(Department of Neurosurgery,Yellow River Central Hospital,Zhengzhou 450000,Henan Province,China;Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China;Department of Neurosurgery,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]黄河中心医院神经外科,河南郑州450000 [2]郑州大学第一附属医院神经外科,河南郑州450000 [3]航空总医院神经外科,北京100012

出　　处：《新乡医学院学报》2023年第10期965-969,共5页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20210613)。

摘　　要：目的 探讨神经减压术治疗偏头痛患者的疗效影响因素并构建预测模型。方法 选择2021年1月至2023年4月于黄河中心医院行神经减压术治疗的124例偏头痛患者为研究对象。患者均给予神经减压术,术后6个月对患者进行疗效评估,并根据治疗效果将患者分为有效组(n=104)和无效组(n=20)。收集患者的临床资料,采用单因素和Lasso-logistic回归分析偏头痛患者神经减压术后疗效的影响因素,并与全变量logistic回归、逐步logistic回归的结果进行比较。根据Lasso-logistic回归分析的结果构建列线图预测模型,并采用校准曲线、决策曲线评价预测模型的区分度、准确度及临床实用性。结果 术后6个月,124例患者中显效24例,有效80例,无效20例,总有效率为83.87%(104/124)。单因素分析结果显示,有效组与无效组患者偏头痛病程、偏头痛程度、偏头痛发作持续时间、偏头痛发作频率、术后血清5-羟色胺(5-HT)、血管活性肠肽(VIP)、β-内啡肽(β-EP)和肿瘤坏死因子-α(TNF-α)水平比较差异有统计学意义(P<0.05);Lasso-logistic回归分析结果显示,偏头痛发作频率高、术后血清5-HT、VIP、β-EP低水平及TNF-α高水平是影响偏头痛患者神经减压术后临床疗效的独立危险因素(P<0.05);与全变量logistic回归和逐步logistic回归相比,Lasso-logistic回归模型的赤池信息量准则、贝叶斯信息准则最小;构建的列线图预测模型具有较好的区分度、准确度及临床实用性。结论 偏头痛发作频率高及术后血清5-HT、VIP、β-EP低水平和TNF-α高水平是偏头痛患者神经减压术后临床疗效的独立影响因素,基于上述影响因素建立的预测模型对临床疗效具有一定预测价值。Objective To explore the influencing factors of efficacy of nerve decompression surgery in the treatment of migraine patients and construct the prediction model.Methods A total of 124 migraine patients who underwent nerve decompression surgery in Yellow River Central Hospital from January 2021 to April 2023 were selected as the research subjects.All patients underwent nerve decompression surgery,and the efficacy was evaluated at six months after the surgery.Patients were divided into the effective group(n=104)and the ineffective group(n=20)according to the treatment effect.The clinical data of patients were collected,and the influencing factors of postoperative efficacy of nerve decompression surgery in migraine patients were analyzed by univariate and Lasso-logistic regression analysis,and then the results were compared with the full variable logistic regression and stepwise logistic regression.The nomogram chart prediction model was constructed based on the results of Lasso-logistic regression analysis,and the discrimination,accuracy and clinical utility of the prediction model were evaluated by calibration curve and decision curve analysis.Results At six months after surgery,of the 124 patients,24 cases were significantly effective,80 cases were effective,and 20 cases were ineffective;the total effective rate was 83.87%(104/124).The results of univariate analysis showed that there were significant differences in the course of disease,degree,duration of attacks,seizure frequency of migraine and the serum 5-hydroxytryptamine(5-HT),vasoactive intestinal peptide(VIP),β-endorphin(β-EP),tumour necrosis factor-α(TNF-α)levels of patients between the effective group and the ineffective group(P<0.05);Lasso-logistic regression analysis showed that high frequency of migraine attacks,lower levels of 5-HT,VIP,β-EP and higher level of TNF-αin serum after surgery were independent risk factors of clinical efficacy in migraine patients after nerve decompression surgery(P<0.05).Compared with the full variable logistic regr

关 键 词：偏头痛 神经减压术 Lasso-logistic回归模型 列线图模型 

分 类 号：R745.1[医药卫生—神经病学与精神病学]