构建模型预测经皮球囊压迫治疗后三叉神经痛复发

Constructing model for predicting recurrence of trigeminal neuralgia after percutaneous balloon compression

目的构建预测三叉神经痛(TN)经皮球囊压迫(PBC)治疗后复发模型,分析疼痛复发相关因素。方法回顾性分析261例经PBC治疗的TN患者,以其中167例为训练集、94例为测试集;根据疼痛是否复发将前者分为复发亚组(n=95)与未复发亚组(n=72),比较亚组间基本资料,获取疼痛复发相关因素,建立多因素logistic回归模型;以受试者工作特征曲线评估模型预测训练集和测试集PBC后PN复发的效能,比较模型在训练集与验证集曲线下面积(AUC)的差异。结果训练集中,相比未复发亚组,复发亚组肥胖、合并多发性硬化症、TN病程≥5年、治疗前巴罗神经病学研究所疼痛分级Ⅳ或Ⅴ、非典型疼痛及球囊压迫时间>120 s者占比较高,而V3分区疼痛者占比较低(P均<0.05)。肥胖[OR=1.662,95%CI(1.176,2.350)]、合并多发性硬化症[OR=1.707,95%CI(1.195,2.439)]、TN病程≥5年[OR=2.016,95%CI(1.364,2.979)]、非典型疼痛[OR=2.551,95%CI(1.508,4.310)]及球囊压迫时间>120 s[OR=2.044,95%CI(1.222,3.419)]均与疼痛复发风险增加有关,而V3分区疼痛[OR=0.874,95%CI(0.787,0.970)]患者复发风险较低(P均<0.05);由以上因素构建的多因素logistic回归模型预测训练集与测试集疼痛复发的AUC分别为0.789及0.792,差异无统计学意义(P=0.842)。结论所获模型可用于预测PBC后TN复发;肥胖、合并多发性硬化症、TN病程≥5年、非典型疼痛等及球囊持续压迫时间>120 s可增加PBC后TN复发风险,而V3分区疼痛治疗后复发风险较低。

Objective To construct a model for predicting recurrence of trigeminal neuralgia(TN)after percutaneous balloon compression(PBC),and to explore the relative factors of pain recurrence.Methods Data of 261 TN patients who underwent PBC were retrospectively analyzed,including 167 cases in training set and 94 cases in test set.According to pain recurred or not,patients in the training set were divided into recurrence(n=95)and non-recurrence subgroup(n=72).The general data were compared between subgroups to identify relative factors of pain recurrence,then a multivariate logistic regression model for predicting pain recurrence after PBC was established,and its predicting performances of previous regression model were evaluated with receiver operating characteristic curves in both training and test set,and the areas under the curves(AUC)were compared between sets.Results In training set,compared with those in nonrecurrence subgroup,the proportions of obesity,complicating multiple sclerosis,TN duration≥5 years,preoperative Barrow Neurological Institute pain grade ofⅣorⅤ,atypical pain and balloon compression time>120 s were all higher,but the proportion of patients with V3 zone pain was lower in recurrence subgroup(all P<0.05).Obesity(OR=1.662,95%CI[1.176,2.350]),complicating multiple sclerosis(OR=1.707,95%CI[1.195,2.439]),TN duration≥5 years(OR=2.016,95%CI[1.364,2.979]),atypical pain(OR=2.551,95%CI[1.508,4.310])and balloon compression time>120 s(OR=2.044,95%CI[1.222,3.419])were significantly associated with increased risk of pain recurrence,while V3 zone pain(OR=0.874,95%CI[0.787,0.970])was associated with decreased recurrence risk(all P<0.05).No significant difference of AUC of the logistic regression model constructed with these factors for predicting pain recurrence was found between training and test sets(0.789 and 0.792,P=0.842).Conclusion The obtained model could be used to predict TN recurrence after PBC.Obesity,complicating multiple sclerosis,TN duration≥5 years,atypical pain and balloon compression time>120 s were associated with increased risk of TN recurrence,while V3 zone pain associated with a decreased risk of recurrence.