中青年腰椎间盘退行性病变预测模型的建立与验证  

Establishment and validation of a predictive model for degenerative lumbar disc disease in young and middle-aged

作　　者：毛振飞 徐良 史昱晖[1] 朱立帆[1] 曾金才[1] Mao Zhen-Fei;Xu Liang;Shi Yu-Hui;Zhu Li-Fan;Zeng Jin-Cai(Department of Orthopedics,Suzhou Ninth Hospital Affiliated to Soochow University,Suzhou,Jiangsu 215200,China)

机构地区：[1]苏州大学附属苏州九院骨科,江苏苏州215200

出　　处：《解放军医学杂志》2023年第12期1439-1444,共6页Medical Journal of Chinese People's Liberation Army

基　　金：苏州市科技发展计划(民生科技)项目(SS202090);吴江区科教兴卫项目(WWK202006)。

摘　　要：目的建立中青年腰椎间盘退行性病变列线图预测模型并进行验证。方法纳入2020年1月-2022年3月在苏州大学附属苏州九院行腰椎间盘MRI、标准站立位腰椎正侧位X线检查的232名中青年人作为研究对象,根据有无腰椎退行性病变将研究对象分为退行性病变组(n=78)与无退行性病变组(n=154)。收集可能影响中青年腰椎间盘退行性病变发生的因素,比较两组各影响因素,并以多因素logistic回归筛选出独立影响因素,采用R软件构建列线图模型,并对模型进行验证。结果共纳入232名中青年人,其中78名(33.6%)患有腰椎间盘退行性病变。二元多因素logistic回归分析结果显示,BMI升高、久坐、IL-1β水平升高为中青年腰椎退行性病变的危险因素;骨盆入射角增加、miRNA-142-3p水平升高为中青年腰椎退行性病变的保护性因素(P<0.05)。根据多因素分析结果构建列线图模型,ROC曲线分析显示,AUC为0.889(95%CI0.844~0.933,P<0.05),内部验证平均绝对误差为0.017,预测曲线与标准曲线基本拟合,H-L拟合优度检验结果显示模型一致性较好(P>0.05)。决策曲线显示,当模型预测概率阈值为0.16~0.80时,临床获益率最高。结论中青年腰椎间盘退行性病变受BMI、久坐、骨盆入射角等因素的影响,据此建立的列线图预测模型具有较高的区分度与准确度。Objective To establish and validate the nomogram prediction model of degenerative lumbar disc disease in young and middle-aged people.Methods From January 2020 to March 2022,232 young and middle-aged people who were examined with MRI of lumbar intervertebral disc and standard standing position lumbar anteroposterior and lateral X-ray films in Suzhou Ninth Hospital Affiliated to Soochow University were selected as the study subjects.Collecting the factors that may affect the occurrence of degenerative lumbar disc disease in young and middle-aged people,the people were divided into degenerative disease group(n=78)and non-degenerative disease group(n=154)according to the presence or absence of degenerative lumbar disc disease.Influencing factors were compared between the two groups,the independent influencing factors screened out by multifactor logistic regression,the nomograph model was constructed by R software,and the model verified.Results Among 232 young and middle-aged people included in this study,78(33.6%)had degenerative lumbar disc diseases.The results of multivariate logistic regression analysis showed that the increase of BMI,sedentariness,the increase of IL-1βlevel were the risk factors of degenerative lumbar disc disease in young and middle-aged people;the increase of pelvic incidence angle and the increase of miRNA-142-3p level were protective factors for degenerative lumbar disc disease in young and middle-aged people(P<0.05).The nomogram model was constructed according to the results of multifactor analysis.ROC results showed that AUC was 0.889(95%CI 0.844-0.933,P<0.05),the average absolute error of internal validation was 0.017,the prediction curve was basically fitted with the standard curve,and the H-L goodness of fit test showed that the model was consistent(P>0.05).The decision curve shows that the clinical benefit rate is the highest when the model prediction probability threshold is 0.16-0.80.Conclusions Degenerative lumbar disc disease in young and middle-aged people is affected by such fac

关 键 词：中青年 腰椎间盘退行性病变 多因素分析 列线图 

分 类 号：R681.5[医药卫生—骨科学]