重症肌无力患者复发或疗效不佳的危险因素分析及预测模型建立  

Analysis of risk factors and establishment of prediction model for recurrence or poor efficacy in patients with myasthenia gravis

作　　者：李君莲 李海燕 霍发荣[1] 吴倩 董利萍 陈思 张晓燕 LI Junlian;LI Haiyan;HUO Farong;WU Qian;DONG Liping;CHEN Si;ZHANG Xiaoyan(不详;Department of Neurology,the 940 Hospital of Joint Logistic Support Forces of PLA,Lanzhou Gansu 730050,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院神经内科,730050 [2]甘肃中医药大学第一临床医学院,730000

出　　处：《中国神经免疫学和神经病学杂志》2024年第5期370-375,405,共7页Chinese Journal of Neuroimmunology and Neurology

基　　金：甘肃省科技厅自然科学基金资助项目(21JR11RA003)。

摘　　要：目的探讨重症肌无力(myasthenia gravis,MG)患者复发或疗效不佳的危险因素并构建其风险预测模型。方法回顾性收集2015-1-1—2022-4-1中国人民解放军联勤保障部队第九四〇医院神经内科98例首次确诊MG患者的临床资料,根据患者治疗1年后随访时的病情变化将患者分为缓解组和未缓解组,比较两组患者临床资料的差异,采用多因素Logistics回归分析影响患者复发或预后的独立危险因素,并建立预测模型的列线图,同时利用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线评估该模型对MG患者复发或疗效不佳的预测价值。结果98例MG患者中缓解组61例,未缓解组37例。与缓解组相比,未缓解组MG患者的病程更长、美国MG基金会分型及血天门冬氨酸氨基转移酶水平更高(均P<0.05),不规律服药、有感染诱因、累及四肢躯干、累及呼吸肌者比例均高(P<0.05)。多因素Logistic回归分析提示病程长[OR=1.082,95%CI:1.011~1.157;P=0.022]、不规律服药[OR=4.778,95%CI:1.539~14.833;P=0.007]、有感染诱因[OR=9.217,95%CI:2.856~29.740;P<0.001]、累及四肢躯干[OR=3.298,95%CI:1.093~9.950;P=0.034]为MG患者复发或疗效不佳的独立危险因素。经ROC曲线、校准曲线评估显示,根据上述4个独立危险因素建立的风险预测模型具有较好的区分度及校准度。结论病程长、累及四肢躯干、不规律服药、感染易导致MG患者病情反复或疗效不佳,由上述危险因素所建立的风险预测模型对评估MG患者复发或预后不佳的风险具有较好的预测价值。Objective To investigate the risk factors of relapse or poor outcome in myasthenia gravis(MG)patients and construct a risk prediction model.Methods The clinical data of 98 patients diagnosed with MG for the first time in the Department of Neurology,the 940 Hospital of Joint Logistic Support Forces of PLA were retrospectively collected from January 2015 to April 2022.The patients were divided into remission group and non-remission group according to the changes of the patients′conditions after 1 year of treatment,and the differences of clinical data between the two groups were compared.Multiple factor logistics regression was used to analyze the independent risk factors affecting patients′recurrence or prognosis,and a nomogram of the prediction model was established.At the same time,receiver operating characteristic(ROC)curve and calibration curve evaluated the predictive value of the model for recurrence or poor efficacy in MG patients.Results Among 98 MG patients,there were 61 patients in remission group and 37 patients in non-remission group.Compared with the remission group,MG patients in the non-remission group had longer disease course,higher MGFA type and blood aspartate aminotransferase level(all P<0.05),and higher proportion of patients with irregular medication,infection inducement,involvement of limbs and trunk,and involvement of respiratory muscle(all P<0.05).Multivariate logistic regression analysis suggested long course of disease(OR=1.082,95%CI:1.011-1.157;P=0.022),irregular medication(OR=4.778,95%CI:1.539-14.833;P=0.007],and an inducement of infection(OR=9.217,95%CI:2.856-29.740;P<0.001),involved limbs and trunk(OR=3.298,95%CI:1.093-9.950;P=0.034)were independent risk factors for recurrence or poor response in MG patients.The ROC curve and calibration curve evaluation showed that the risk prediction model based on the above four independent risk factors had a good degree of differentiation and calibration.Conclusions Long course of disease,involvement of limbs and trunk,irregular medication,and

关 键 词：重症肌无力 复发 预后 危险因素 预测模型 ROC曲线 

分 类 号：R746.1[医药卫生—神经病学与精神病学]