摘要
目的 探究中耳风险指数(MERI)及鼓室黏膜情况对慢性中耳炎患者预后的预测价值。方法 选取2022年1月—2023年3月空军军医大学第二附属医院收治的100例慢性中耳炎患者,根据MERI评分分为预后良好组(77例)与预后不良组(23例),比较两组的一般资料,采用多因素一般Logistic回归模型分析慢性中耳炎患者预后不良的影响因素并构建列线图,绘制受试者工作特征(ROC)曲线分析MERI及鼓室黏膜情况对慢性中耳炎患者预后不良的预测价值。结果 预后不良组的咽鼓管功能不良、鼓室黏膜出血、鼓室黏膜纤维化、鼓室黏膜增厚的占比及MERI评分均高于预后良好组(P<0.05)。多因素一般Logistic回归分析结果显示:咽鼓管功能不良[OR=7.482(95%CI:1.086,51.570)]、鼓室黏膜出血[OR=9.476(95%CI:1.354,66.321)]、鼓室黏膜纤维化[OR=7.679(95%CI:1.518,38.840)]、鼓室黏膜增厚([OR=7.228(95%CI:1.296,40.322)]、MERI评分高[OR=2.867(95%CI:1.473,5.579)]均是慢性中耳炎患者预后不良的影响因素(P<0.05)。ROC曲线结果表明,鼓室黏膜出血的曲线下面积(AUC)为0.701,敏感性为73.9%(95%CI:0.516,0.898)、特异性为66.2%(95%CI:0.546,0.766);鼓室黏膜纤维化的AUC为0.774,敏感性为78.3%(95%CI:0.563,0.925),特异性为76.6%(95%CI:0.656,0.855);鼓室黏膜增厚的AUC为0.711,敏感性为69.6%(95%CI:0.471,0.868),特异性为72.7%(95%CI:0.614,0.823);MERI评分的AUC为0.879,敏感性为69.6%(95%CI:0.471,0.868),特异性为92.2%(95%CI:0.838,0.971);鼓室黏膜出血、鼓室黏膜纤维化、鼓室黏膜增厚及MERI评分联合预测的AUC为0.951,敏感性为91.3%(95%CI:0.720,0.989)、特异性为92.2%(95%CI:0.838,0.971)]。结论 MERI及鼓室黏膜情况对慢性中耳炎患者预后有良好的预测价值。
Objective To explore the predictive value of the Middle Ear Risk Index(MERI)and tympanic membrane conditions for the prognosis of patients with chronic otitis media.Methods A total of 100 patients with chronic otitis media, admitted to the Second Affiliated Hospital of Air Force Medical University from January 2022 to March 2023, were enrolled and categorized based on the MERI score into a good prognosis group (n = 77) and a poor prognosis group (n = 23). General data were compared between the two groups, and logistic regression analysis was used to identify factors affecting poor prognosis in patients with chronic otitis media. Receiver operating characteristic (ROC) curves were constructed to analyze the predictive efficacy of poor prognosis. Results The poor prognosis group showed higher instances of eustachian tube dysfunction, tympanic membrane bleeding, tympanic membrane fibrosis, and tympanic membrane thickening, as well as higher MERI scores compared to the good prognosis group (P <0.05). Multivariate logistic regression analysis indicated that eustachian tube dysfunction [OR = 7.482 (95% CI: 1.086, 51.570)], tympanic membrane bleeding [OR = 9.476 (95% CI: 1.354, 66.321) ], tympanic membrane fibrosis [OR = 7.679 (95% CI: 1.518, 38.840) ], tympanic membrane thickening [OR = 7.228 (95% CI: 1.296, 40.322) ], and high MERI scores [OR = 2.867 (95% CI: 1.473, 5.579) ] were significant factors influencing poor prognosis in patients with chronic otitis media (P <0.05). ROC curve results showed that the combined prediction of tympanic membrane bleeding, tympanic membrane fibrosis, tympanic membrane thickening, and MERI score yielded an area under the curve (AUC) of 0.951, with a sensitivity of 91.3% (95% CI:0.720, 0.989) and a specificity of 92.2% (95% CI: 0.838, 0.971). The AUC for tympanic membrane bleeding was 0.701, with a sensitivity of 73.9% (95% CI: 0.516, 0.898) and a specificity of 66.2% (95% CI: 0.546, 0.766);for tympanic membrane fibrosis, the AUC was 0.774, with a sensitivity of 78.3% (95% CI: 0.563, 0.925) and a specificity of 76.6% (95% CI:0.656, 0.855);for tympanic membrane thickening, the AUC was 0.711, with a sensitivity of 69.6% (95% CI:0.471, 0.868) and a specificity of 72.7% (95% CI:0.614, 0.823);and for the MERI score, the AUC was 0.879, with a sensitivity of 69.6% (95% CI: 0.471, 0.868) and a specificity of 92.2% (95% CI: 0.838, 0.971). Conclusion The middle ear risk index and the condition of the tympanic membrane are effective predictors of prognosis in patients with chronic otitis media.
作者
王婉
刘丞程
高伟
郭林燕
周羽
杨晓娜
程建梅
Wang Wan;Liu Cheng-cheng;Gao Wei;Guo Lin-yan;Zhou Yu;Yang Xiao-na;Cheng Jian-mei(Department of Otolaryngology,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi 710038,China;Department of Traditional Chinese Medicine,Genertec Universal Xi'an Bei Huan Hospital,Xi'an,Shaanxi 710032,China)
出处
《中国现代医学杂志》
CAS
2024年第17期91-96,共6页
China Journal of Modern Medicine
基金
陕西省重点研发计划项目(No:S2022-YF-YBSF-0670)。
关键词
慢性中耳炎
中耳风险指数
鼓室黏膜情况
预后
chronic otitis media
middle ear risk index
tympanic membrane conditions
prognosis
