针灸治疗贝尔面瘫临床预测模型的构建与验证

Construction and validation of clinical prediction model of acupuncture and moxibustion for Bellʹs palsy

目的:构建并验证针灸治疗贝尔面瘫的临床预测模型,为针灸治疗贝尔面瘫的疗效预测提供工具。方法:纳入2018年6月至2023年6月于胜利油田中心医院针灸推拿科、莘县中心医院神经内科和东营市中医院康复科就诊,并以针灸为主要治疗方式的贝尔面瘫患者269例,将胜利油田中心医院针灸推拿科、莘县中心医院神经内科182例患者随机分为训练组(128例)和内部验证组(54例),东营市中医院康复科患者作为外部验证组(87例),通过电子病历信息平台提取患者临床资料。采用SPSS25.0和R4.2.3软件,通过单因素和多因素Logistic回归分析,筛选出针灸治疗贝尔面瘫疗效的独立影响因素。并通过内部验证和外部验证的方式,绘制受试者工作特征曲线(ROC)、拟合度曲线和临床决策曲线(DCA),计算模型的灵敏度、特异度、准确度、阳性预测值和阴性预测值,全面评估模型的整体性能。结果:多因素Logistic回归分析结果显示,高龄、治疗前病情重、未在发病72 h内使用激素治疗、急性期未进行针灸和针灸方案单一是针灸治疗贝尔面瘫疗效不佳的独立影响因素(P<0.05,P<0.01)。基于此构建了列线图模型和在线列线图预测工具(https://bmuchen.shinyapps.io/dynnomapp/)。模型在训练组、内部验证组和外部验证组的ROC曲线下面积(AUC)分别是0.921(95%CI:0.877,0.966)、0.876(95%CI:0.787,0.966)和0.846(95%CI:0.766,0.926),具有良好的预测价值。模型与校准曲线贴合较好。决策曲线阈值在0~0.8之间时,可为临床参与者提供临床获益。模型的灵敏度在65.9%~88.0%、特异度在77.3%~90.7%、准确度在77.8%~85.9%、阳性预测值在83.3%~90.1%、阴性预测值在70.8%~78.7%,综合评估该模型的临床应用价值较好。结论:针灸治疗贝尔面瘫的临床预测模型具有一定的实际应用价值和可推广性,预测结果可以辅助临床医师对针灸治疗贝尔面瘫的疗效进行判定,做出有效优质的临床决策,制定最佳的治疗计划。

Objective To establish and validate a clinical prediction model of acupuncture and moxibustion for Bell's palsy so as to provide a tool for predicting the effect of acupuncture and moxibustion on Bell's palsy.Methods A total of 269 patients with Bell's palsy were collected from department of acupuncture,moxibustion and tuina,Shengli Oilfield Central Hospital,neurology department,Shenxian County Central Hospital and department of rehabilitation medicine,Dongying Municipal Hospital of TCM from June 2018 to June 2023.All of these cases were treated with acupuncture and moxibustion.Of them,182 cases,from department of acupuncture,moxibustion and tuina,Shengli Oilfield Central Hospital and neurology department,Shenxian County Central Hospital,were randomized into a training group(128 cases)and an internal validation group(54 cases);87 cases from department of rehabilitation medicine,Dongying Municipal Hospital of TCM were assigned to an external validation group.The clinical data of all of the cases were extracted from the electronic medical record information platform.Using SPSS25.0 and R4.2.3,through univariate and multivariate Logistic regression analysis,the independent factors influencing the effects of acupuncture and moxibustion on Bell's palsy were identified.By means of internal and external validations,the receiver operating characteristic curve(ROC),the goodness-of-fit curve(GFC)and the decision curve analysis(DCA)were plotted.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the model were calculated;and its comprehensive performance was evaluated.Results The results of the multivariate Logistic regression analysis showed that the independent factors for the unsatisfactory effect on Bell's palsy were advanced age,severe symptoms before treatment,no use of steroids within 72 h of onset,and lack of acupuncture-moxibustion therapy during the acute phase or single acupuncture-moxibustion protocol(P<0.05,P<0.01).Based on these factors,nomogram model and online columnar plot prediction tool(https://bmuchen.shinyapps.io/dynnomapp/)were established.The area under the ROC curve of the model was 0.921(95%CI:0.877,0.966),0.876(95%CI:0.787,0.966),and 0.846(95%CI:0.766,0.926)in the training group,the internal validation group,and the external validation group,respectively,indicating good predictive value.The model showed a satisfactory calibration curve alignment.The decision threshold in the range of 0 to 0.8 provided clinical benefits for participants.The model exhibited the sensitivity from 65.9%to 88.0%,the specificity ranging from 77.3%to 90.7%,the accuracy from 77.8%to 85.9%,the positive predictive value from 83.3%to 90.1%,and the negative predictive value from 70.8%to 78.7%.The comprehensive evaluation indicated a satisfactory clinical application value of the model.Conclusion The clinical prediction model of acupuncture and moxibustion for Bell's palsy is valuable in its practice and promotion to a certain extent.The predicted results are conductive to clinicians'judgement of the effect of acupuncture and moxibustion for this disease and making effective and high-quality clinical decisions,as well as formulating the optimal therapeutic regimen.