针灸治疗对神经根型颈椎病预后影响的列线图模型构建

Effect Nomogram Model Construction of Acupuncture and Moxibustion on Prognosis of Cervical Spondylotic Radiculopathy

目的:构建基于LASSO-Cox的针灸治疗对神经根型颈椎病(cervical spondylotic radiculopathy,CSR)临床预后影响的列线图模型。方法:选取2020年1月至2021年12月接受针灸治疗的CSR患者150例,使用LASSO-Cox筛选针灸治疗对CSR患者临床预后的影响因素,采用R软件(R 3.6.3版)构建预测针灸治疗对CSR患者临床预后的列线图预测模型,用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线及Hosmer-Lemeshow拟合优度检验评估本研究构建的列线图预测模型的预测效能。结果:有效组与无效组在年龄、病程、性别、有无颈部外伤、睡眠时间、伏案工作时间、体育锻炼次数、针灸频次等方面比较,差异有统计学意义(P<0.05)。多因素Cox回归模型结果提示,病程、伏案工作时间、体育锻炼次数、针灸频次为针灸治疗对CSR临床预后的独立影响因素。绘制ROC曲线、校准曲线以及进行Hosmer-Lemeshow拟合优度检验,结果显示:ROC曲线下面积为0.818(95%CI=0.747~0.888),曲线斜率接近1,Hosmer-Lemeshow拟合优度检验χ^(2)=6.146,P=0.631。结论:使用LASSO-Cox回归筛选针灸治疗对CSR临床预后的影响因素,以此为基础初步构建了列线图模型,具有较好的预测效能。

Objective:To construct a nomogram model of the effect of acupuncture-moxibustion treatment on the clinical prognosis of cervical spondylotic radiculopathy(CSR) based on LASSO-Cox.Methods:A total of 150 CSR patients who received acupuncture and moxibustion from January 2020 to December 2021 were selected.LASSO-Cox was applied to screen the influencing factors of acupuncture treatment on the clinical prognosis of CSR patients,R software(version R 3.6.3) was applied to construct a nomogram prediction model for predicting the clinical prognosis of CSR patients with acupuncture treatment,receiver operating characteristic(ROC) curve,calibration curve and Hosmer-Lemeshow goodness-of-fit test were applied to evaluate the predictive performance of the nomogram prediction model constructed in this study.Results:There were statistically significant differences between the effective group and the ineffective group in terms of age,course of the disease,gender,neck trauma,sleep time,desk work time,number of physical exercises,and frequency of acupuncture and moxibustion(P<0.05).The results of the multivariate Cox regression model indicated that the course of the disease,desk work time,physical exercise frequency,and the frequency of acupuncture and moxibustion were the independent influencing factors of acupuncture treatment on the clinical prognosis of CSR.The ROC curve and calibration curve were drawn,and the Hosmer-Lemeshow goodness of fit test was performed,the results show that the area under the ROC curve was 0.818(95%CI=0.747-0.888),the slope of the curve was close to 1,and the Hosmer-Lemeshow goodness of fit test χ^(2)=6.146,P=0.631.Conclusion:The influencing factors of acupuncture treatment on the clinical prognosis of CSR were screened out by LASSO-Cox regression,and a nomogram model was initially constructed based on this,which has good predictive performance.