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牙周病是一种发生在牙龈、牙槽骨、牙周膜等牙齿支持组织的慢性、进行性、破坏性的口腔疾病,包括牙周炎和牙龈病两大类,临床常主诉为口腔异味、刷牙出血、咬合疼痛、牙龈肿胀、牙齿松动、食物嵌塞等[1-2]。我国第三次口腔健康流行病学调查显示老年人中仅有14.1%的牙周处于健康状态, 老年人由于自身免疫力和修复能力下降,对疾病认知也相对缺乏,故是牙周病的高发人群[3]。牙周病病程较长,早期由于病情较轻,无自觉症状或症状不明显易被忽视。当病情逐渐加重化,病人有明显症状时往往已进入晚期,此时牙周组织严重萎缩,甚至无法治疗而做拔除处理,不仅严重影响病人的生活质量,还有可能增加病人全身共病的发病风险,故如何预测和控制病情的发展对牙周病病人预后尤其重要[4-5]。目前国内外已就牙周病的多因素致病性展开了大量探究,但尚未能进一步构建可有效预测牙周病严重程度的模型[6-7]。列线图是一种基于多因素回归模型,由风险指标及其对应的带有刻度的线段组成的可视化模型,近年来被临床广泛应用于预测风险事件[8-9]。基于此,本研究拟分析老年牙周病病人病情严重程度的影响因素,并在此基础上建立相关列线图预测模型,旨在为临床控制老年牙周病病情进展、改善病人预后提供参考依据。
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279例病人中探诊出血阳性者为275例,轻度牙周病83例(29.7%),中重度牙周病196例(70.3%)。
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轻度牙周病病人69例(轻度组),中重度牙周病病人144例(中重度组),对比2组资料,结果显示:中重度组病人年龄≥70岁、吸烟、糖尿病、偏侧咀嚼和刷牙频率 < 2次/天者多于轻度组,差异有统计学意义(P < 0.01)(见表 1)。
因素 轻度组(n=69) 中重度组(n=144) χ2 P 性别 < 男 41 98 1.53 >0.05 < 女 28 46 年龄/岁 < < 70 47 65 9.88 < 0.01 < ≥70 22 79 BMI/(kg/m2) < 24 55 113 0.04 >0.05 ≥24 14 31 文化程度 小学及以下 43 97 中学 20 34 0.72 >0.05 专科及以上 6 13 居住地 农村 41 76 0.83 >0.05 城镇 28 68 吸烟 24 82 9.17 < 0.01 饮酒 28 57 0.02 >0.05 糖尿病 5 35 8.90 < 0.01 冠心病 11 27 0.25 >0.05 高血压 16 31 0.08 >0.05 高血脂 11 23 0.00 >0.05 拔牙史 6 13 0.01 >0.05 义齿 有 7 21 0.81 >0.05 无 62 123 偏侧咀嚼 27 85 7.41 < 0.01 刷牙频率/(次/天) < 2 21 74 8.29 < 0.01 ≥2 48 70 定期口腔检查 是 10 19 0.07 >0.05 否 59 125 表 1 老年牙周病病人病情进展至中重度的单因素分析
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以老年牙周病病人病情严重程度为因变量(中重度=1,轻度=0),以中重度组和轻度组单因素分析中有统计学意义的5个项目[年龄(≥70岁=1, < 70岁=0);吸烟(是=1,否=0);糖尿病(是=1,否=0);偏侧咀嚼(是=1,否=0);刷牙频率(< 2次/天=1,≥2次/天=0)]为自变量,进行二分类logistic回归分析,结果显示:年龄≥70岁、吸烟、糖尿病、偏侧咀嚼、刷牙频率 < 2次/天是老年牙周病病人病情进展至中重度的独立危险因素(P < 0.05~P < 0.01)(见表 2)。
项目 B SE Waldχ2 P OR(95%CI) 年龄(≥70岁) 0.910 0.334 7.45 < 0.01 2.485(1.292~4.778) 吸烟(是) 0.952 0.330 8.33 < 0.01 2.591(1.357~4.946) 糖尿病(是) 1.294 0.529 5.99 < 0.05 3.648(1.294~10.284) 偏侧咀嚼(是) 0.814 0.324 6.32 < 0.05 2.257(1.197~4.258) 刷牙频率(< 2次/天) 0.710 0.334 4.52 < 0.05 2.034(1.057~3.916) 常量 -0.960 0.338 8.09 < 0.01 0.383(-) 表 2 老年牙周病病人病情进展至中重度的多因素logistic回归分析
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本研究基于筛选出的5项独立危险因素建立了预测老年牙周病病人病情进展至中重度的列线图模型(见图 1)。模型验证结果显示:训练集和验证集的C-index分别为0.734(95%CI:0.712~0.758)和0.717(95%CI:0.698~0.738);两集的校正曲线和理想曲线拟合反映均较好(见图 2);两集的ROC曲线下面积(AUC)分别为0.751和0.748(见图 3)。
个体化预测老年牙周病病人病情严重程度的风险列线图模型的建立与验证
Establishment and validation of risk nomogram model for individual prediction of severity of periodontal disease in elderly patients
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摘要:
目的构建可个体化预测老年牙周病病人病情严重程度的风险列线图模型,并对模型的预测效能进行验证。 方法选取279例老年牙周病病人作为研究对象,收集病人相关资料,采用单因素和logistic回归多因素分析影响老年牙周病病人病情进展至中重度的相关因素,并建立列线图预测模型。 结果279例中,轻度83例(29.7%),中重度196例(70.3%)。年龄≥70岁、吸烟、糖尿病、偏侧咀嚼、刷牙频率 < 2次/天是老年牙周病病人病情进展至中重度的独立危险因素(P < 0.05~P < 0.01)。基于以上5项危险因素建立相关列线图模型,并对该模型进行验证。结果显示:训练集和验证集的C-index分别为0.734(95%CI:0.712~0.758)和0.717(95%CI:0.698~0.738),两集的校正曲线和理想曲线拟合反映均较好,两集的AUC分别为0.751和0.748。 结论老年牙周病病人病情进展至中重度的危险因素较多,本研究基于危险因素建立的列线图模型具有良好的预测能力,可为临床早期控制牙周病病情发展提供参考依据。 Abstract:ObjectiveTo construct a risk nomogram model for predicting the severity of periodontal disease in elderly patients, and to verify the predictive efficacy of the model. MethodsA total of 279 elderly patients with periodontal disease were selected as the research objects, and the relevant data of the patients were collected.Univariate logistic regression was used to analyze the related factors affecting the progression of the elderly patients with periodontal disease to moderate to serve level, and the nomogram prediction model was established. ResultsAmong the 279 cases, 83 cases (29.7%) were mild, 196 cases (70.3%) were moderate and severe.Age ≥70 years old, smoking, diabetes mellitus, unilateral chewing, brushing frequency < 2 times/d were the independent risk factors for the progression of moderate to severe periodontal disease in elderly patients (P < 0.05 to P < 0.01).Based on the above five risk factors, the relevant nomogram model was established and verified.The results showed that the C-index of training set and validation set were 0.734 (95%CI: 0.712-0.758) and 0.717 (95%CI: 0.698-0.738), respectively.The calibration curve and ideal curve fitting of the two sets were well reflected, and the AUC of the two sets were 0.751 and 0.748, respectively. ConclusionsThere are many risk factors for the progression of periodontal disease in elderly patients.The nomogram model based on risk factors has good predictive ability, which can provide reference for early clinical control of periodontal disease. -
Key words:
- periodontal disease /
- elderly patients /
- disease severity /
- risk factors /
- nomogram
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表 1 老年牙周病病人病情进展至中重度的单因素分析
因素 轻度组(n=69) 中重度组(n=144) χ2 P 性别 < 男 41 98 1.53 >0.05 < 女 28 46 年龄/岁 < < 70 47 65 9.88 < 0.01 < ≥70 22 79 BMI/(kg/m2) < 24 55 113 0.04 >0.05 ≥24 14 31 文化程度 小学及以下 43 97 中学 20 34 0.72 >0.05 专科及以上 6 13 居住地 农村 41 76 0.83 >0.05 城镇 28 68 吸烟 24 82 9.17 < 0.01 饮酒 28 57 0.02 >0.05 糖尿病 5 35 8.90 < 0.01 冠心病 11 27 0.25 >0.05 高血压 16 31 0.08 >0.05 高血脂 11 23 0.00 >0.05 拔牙史 6 13 0.01 >0.05 义齿 有 7 21 0.81 >0.05 无 62 123 偏侧咀嚼 27 85 7.41 < 0.01 刷牙频率/(次/天) < 2 21 74 8.29 < 0.01 ≥2 48 70 定期口腔检查 是 10 19 0.07 >0.05 否 59 125 表 2 老年牙周病病人病情进展至中重度的多因素logistic回归分析
项目 B SE Waldχ2 P OR(95%CI) 年龄(≥70岁) 0.910 0.334 7.45 < 0.01 2.485(1.292~4.778) 吸烟(是) 0.952 0.330 8.33 < 0.01 2.591(1.357~4.946) 糖尿病(是) 1.294 0.529 5.99 < 0.05 3.648(1.294~10.284) 偏侧咀嚼(是) 0.814 0.324 6.32 < 0.05 2.257(1.197~4.258) 刷牙频率(< 2次/天) 0.710 0.334 4.52 < 0.05 2.034(1.057~3.916) 常量 -0.960 0.338 8.09 < 0.01 0.383(-) -
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