摘要
目的构建个体化预测丘脑底核脑深部电刺激术(subthalamic nucleus-deep brain stim,STN-DBS)治疗帕金森病患者近期预后的列线图模型,并评价该模型的临床准确性和适用性。方法随机选取2015年1月1日—2022年1月1日于聊城市人民医院脑科医院功能神经外科行ST N-DB S治疗的帕金森病患者,所有患者随访1年,剔除失访患者,根据药物关期Schwab&England日常生活活动量表(Schwab and England Scale,S&E)评分分为预后良好组(S&E评分>70分)和预后不良组(S&E评分≤70分),通过多因素Logistic回归分析导致脑深部电刺激术治疗帕金森病患者近期预后不良的独立危险因素,基于上述独立危险因素利用R语言构建列线图模型,利用Bootstrap法验证构建模型的预测准确性,利用受试者工作特征曲线验证构建的临床模型的预测效能,利用临床决策曲线评价构建的预测模型的临床获益性。结果预后良好者组共50例,预后不良组共35例。通过多因素Logistics回归分析导致STN-DBS治疗帕金森病患者近期预后不良的独立危险因素为:发病年龄、Hoehn-Yahr分期、手术年龄、简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)以及帕金森统一评估量表评分Ⅱ(Unified Parkinson's Disease Rating ScaleⅡ,UPDRSⅡ)。基于上述独立危险因素构建的列线图预测模型,受试者工作特征曲线验证显示其预测能力较强,曲线下面积为0.88,95%CI:0.71~0.94;Bootstrap法验证构建模型相关数据显示其构建模型的预测准确性较好:C-index 0.867,95%CI:0.814~0.928;Calibration plot预测脑深部电刺激术治疗帕金森病患者近期预后不良风险与实际发生风险的平均绝对误差为0.011;Hosmer-Lemeshow检验结果显示无统计学意义(χ^(2)=5.062,P=0.663);临床获益曲线显示当M ACCE发生阈值为0.11~0.97时该模型的临床获益性以及适用性最佳。结论发病年龄、Hoehn-Yahr分期、手术年龄、MMSE以及U PDR SⅡ是导致S
Objective To construct an individualized short-term prognostic nomogram model for Parkinson's disease(PD)patients undergoing subthalamic nucleus-deep brain stimulation(STN-DBS),and to assess the clinical accuracy and applicability of this model.Methods Parkinson's disease patients who underwent STN-DBS treatment at Brain Hospital of Liaocheng People's Hospital between January 1,2015 and January 1,2022 were randomly selected and followed up for one year except those were out of contact.Patients were divided into the good prognosis group(S&E score>70 points)and the poor prognosis group(S&E score≤70 points)based on the Schwab and England Scale(S&E score)related to the medication phase.Independent risk factors for poor short-term prognosis of PD patients undergoing deep brain stimulation were analyzed using multifactorial logistics analysis.A nomogram model was constructed using R language based on the above independent risk factors.The Bootstrap method was employed to validate the accuracy of prediction of the model,while the receiver operating characteristic(ROC)curve was used to evaluate the predictability of the model.The decision curve analysis was used to assess the clinical benefit of the model.Results There were 50 patients in the good prognosis group and 35 in the poor prognosis group.Identified through multifactorial logistics analysis,independent risk factors leading to poor short-term prognosis of STN-DBS treatment for PD patients included the age of onset,Hoehn-Yahr staging,surgical age,mini-mental state examination(MMSE)score,and Unified Parkinson's Disease Rating ScaleⅡ(UPDRSⅡ)score.The prognostic nomogram model constructed based on these independent risk factors demonstrated strong predictability,with an area under the curve(AUC)of 0.88,95%CI:0.71-0.94,according to the ROC curve.Bootstrap validation of the model-related data showed good accuracy of prediction:C-index 0.867,95%CI:0.814-0.928.The calibration plot predicted an average absolute error of 0.011 for the risk of poor short-term prognosi
作者
祝秋实
刘怀新
耿凤阳
刘培慧
姜扬
ZHU Qiushi;LIU Huaixin;GENG Fengyang;LIU Peihui;JIANG Yang(Functional Neurosurgery,Brain Hospital of Liaocheng People's Hospital,Liaocheng 252001;Department of Neurointerventional,Huludao Central Hospital,Huludao 125000;Department of Neurology,Neurology First People's Hospital,Shenyang 110016,China)
出处
《空军航空医学》
2023年第6期514-520,共7页
AVIATION MEDICINE OF AIR FORCE
基金
辽宁省自然科学基金(2019-221、2019-645)
沈阳市科技计划项目(19-112-4-040)。
关键词
脑深部电刺激术
帕金森病
简易精神量表评分
预后
Subthalamic nucleus deep brain stimulation
Parkinson's disease
MMSE
Prognosis
