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    徐州某高校大学生颞下颌关节功能紊乱综合征治疗效果预测模型的建立与验证

    Establishment and validation of a predictive model for the treatment effect of temporomandibular joint dysfunction syndrome among students in a college of Xuzhou

    • 摘要: 目的 建立颞下颌关节功能紊乱综合征(TMJDS)治疗效果预测模型,并验证其效能。方法 纳入2019年3月—2023年3月在徐州工业职业技术学院卫生所治疗的346例TMJDS患者,按照3∶1比例分别纳入训练集(n=259)、验证集(n=87)。按照训练集患者治疗前后临床症状及中医证候积分变化评估其治疗效果,并比较治疗有效、无效患者的临床资料,包括年龄、性别、病程、张口度等,使用Logistic多因素回归模型分析影响患者治疗效果的风险因素,基于风险因素建立列线图模型,完善模型内部验证、效能分析和决策曲线分析(DCA)。结果 训练集、验证集总有效率分别为88.03%、88.51%,组间比较差异无统计学意义(P>0.05)。训练集治疗有效、无效患者病程、张口度、偏侧咀嚼情况、治疗方案比较,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示,病程每增加1个月、张口度每降低0.1 cm、偏侧咀嚼均为TMJDS患者治疗无效的独立风险因素,活络散外敷、红外线照射、心理疏导为保护性因素(P<0.05)。内部验证结果显示,训练集、验证集曲线下面积分别为0.967、0.844。Hosmer-Lemeshow检验结果示模型校准度良好(χ2=5.343,P=0.720)。DCA结果显示,在5%~60%阈值范围内,训练集、验证集决策曲线均位于都干预、都不干预上方。结论 TMJDS患者治疗无效可能与病程、张口度、咀嚼习惯、治疗方案有关,基于风险因素建立的列线图模型效能良好、净收益率较高,能够为患者疗效预测提供可靠参考。

       

      Abstract: Objective To establish a model for predicting the therapeutic effect of temporomandibular joint disorder syndrome (TMJDS) and validate its efficiency.Methods A total of 346 patients with TMJDS who were admitted to the Health Center of Xuzhou College of Industrial Technology from March 2019 to March 2023 were included.They were divided into in a training set (n=259) and a verification set (n=87) at a ratio of 3:1. According to the changes of clinical symptoms and TCM syndrome scores of patients in the training set before and after treatment, their therapeutic effect was evaluated, and the clinical data of patients with effective and ineffective treatment were compared, including age, gender, duration of illness, and mouth opening degree, etc. Logistic multivariate regression model analysis was used to analyze the risk factors affecting treatment effect.A nomogram model was established based on the risk factors, and internal validation, efficiency analysis and decision curve analysis (DCA) were conducted.Results The total effective rate in the training set and verification set was 88.03% and 88.51%, respectively, without statistically difference between the groups (P>0.05). Differences in duration of illness, mouth opening, unilateral mastication and treatment plan between the effective and ineffective patients in the training set were statistically significant (P<0.05). Logistic multivariate regression analysis showed that the increase of illness duration by one month, the decrease of mouth opening degree by 0.1 cm, and unilateral mastication were the independent risk factors for ineffective treatment in TMJDS patients, while active external application of Huoluo powder, infrared radiation and psychological counseling were protective factors (P<0.05). The internal validation results showed that the AUC of the training set and the verification set was 0.967 and 0.844, respectively. Hosmer-Lemeshow test showed that the calibration of the model was good (χ2=5.343, P=0.720). DCA results showed that the decision curves for the training and validation sets were located above both intervention and non-intervention lines within the threshold range of 5%~60%.Conclusions The ineffective treatment of patients with TMJDS may be related to illness duration, mouth opening, chewing habit and treatment plans. The nomogram model established on the risk factors demonstrates good efficacy and high net yield, providing reliable reference for predicting treatment effect.

       

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