改良龋病风险评估工具对龋病风险的预测效果

The prediction effect of modified caries risk assessment tool on children's caries risk

目的:探索改良龋病风险评估工具(MCAT)对南宁市儿童龋病风险的预测效果。方法:结合广西儿童龋病的特点,对美国儿童牙医学会(AAPD)推荐的龋病风险评估工具(CAT)进行改良,开发形成MCAT;分别采用CAT和Cariogram两种评分法对MCAT进行龋病风险等级的评判。以广西南宁市江南区332例3岁儿童作为调查对象,通过问卷调查和口腔检查,追踪观察1.5年后龋病的发病情况,比较MCAT采用CAT评分法和Cariogram评分法对该群体新发龋的预测诊断效能。结果:CAT和cariogram评判的患龋风险等级有统计学差异(Z=-10.34,P<0.001),且一致性较差(Kappa=0.234,P<0.001)。1.5年后,CAT评分法中的低-高风险组、中-高风险组的龋病发病率及中-高风险组的新增龋均存在统计学差异(P<0.05);Cariogram评分法中的各组间龋病发病率及低-高风险组、中-高风险组的新增龋均存在统计学差异(P<0.05)。Cariogram评分法的AUC为0.722,显著大于CAT评分法的AUC(0.571)。在龋病风险预测模型中,CAT评分法的龋病风险预测模型的拟合度较差(P<0.001);Cariogr am评分法的预测模型的拟合度较好(P=1.00),中、高风险组发生新龋的风险分别是低风险组的2.86倍和11.65倍。结论:对于3岁儿童的龋病风险评估,MCAT结合Cariogram评分法准确度高于CAT评分法。

Objective:To explore the efficiency of a modified caries risk assessment tool(MCAT)on caries-risk prediction of children in Nanning.Methods:MCAT was designed based on caries-risk assessment tool(CAT)of American Academy of Pediatric Dentistry(AAPD)and the caries related factors of the primary school children in Guangxi,China.A cohort study was conducted in 332 children aged 3-year-old in kindergarten of Jiangnan District,Nanning,Guangxi.The data were integrated through questionnaires and oral examination.The MCAT data were respectively scored by CAT and Cariogram and the caries-risk of the children was evaluated.The development of increased average caires incidece over a period of 1.5 years was compared,the predictive capacity of the methods was compared.Results:The ranks of caires risk assessed by CAT and Cariogram were significant different(Z=-10.34,P<0.001),and the consistency of the 2 methods was poor(Kappa=0.234,P<0.001).After 1.5 year s,there was significant statistical difference of the caries prevalence rate between the low-high and moderate-high risk groups,and dmft increments between the moderate-high risk groups evaluated by CAT(P<0.05).There was significant difference of the caries prevalence rate between each risk groups and dmft incr ements between the low-high and moderate-high risk groups evaluated by Cariogram(P<0.05).The AUC of CAT and Cariogram was 0.571 and 0.722 respectively(P<0.001).In the prediction models of caries risk,the fitting of CAT was poor(P<0.001),while that of Cariogram was better(P=1.00).Cariogram analysis showed that the chance of developing new caries lesions of the subjects with moderate and high caries risk was 2.86 and 11.65 times more than those with low caries risk.Conclusion:MCAT combined with Cariogram can more efficiently predict new caries development in 3-year-old children.