摘要
目的 探究308 nm准分子激光联合白灵片治疗进展期白癜风疗效的影响因素,并建立可预测308 nm准分子激光联合白灵片治疗疗效的列线图预测模型。方法 回顾性选取2023年1月至2024年5月周口市中心医院收治的367例进展期白癜风患者作为研究对象,所有患者均采取308 nm准分子激光联合白灵片治疗,治疗12周后根据疗效分为有效组和无效组,比较两组患者的临床资料,采用多因素Logistic回归分析308 nm准分子激光联合白灵片治疗进展期白癜风疗效的影响因素,应用R语言建立列线图预测模型,采用校正曲线、受试者工作特征(ROC)曲线及曲线下面积(AUC)、决策曲线评估模型的校准度、区分度和临床有效性。结果 367例进展期白癜风患者中痊愈123例,显效120例,好转56例,无效68例,总有效率为81.47%;两组患者的焦虑、睡眠状态、病情程度、病程、疾病分型、肠道菌群失调、白蛋白、游离三碘甲状腺原氨酸(FT3)、可溶性程序性死亡受体配体1 (sPD-L1)、长链非编码RNA肺癌转移相关转录本1 (LncRNA MALAT1)表达比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,焦虑、病情程度、病程、肠道菌群失调、s PD-L1、LncRNA MALAT1表达均是影响308 nm准分子激光联合白灵片治疗进展期白癜风疗效的危险因素(P<0.05),而白蛋白是影响其疗效的保护因素(P<0.05);列线图预测模型AUC为0.875 (95%CI:0.826~0.923),预测概率与实际疗效之间具有较高的一致性,在0~80%阈值概率下,本研究所构建的列线图预测模型净获益均高于ALL线和None线。结论 基于焦虑、病情程度、病程、肠道菌群失调、s PD-L1、LncRNA MALAT1表达、白蛋白等指标构建的308 nm准分子激光联合白灵片治疗进展期白癜风疗效的预测模型具有一定可行性,且预测价值较好,临床应用可靠。
Objective To explore the factors influencing the efficacy of 308 nm excimer laser combined with Bailing tablets in the treatment of progressive vitiligo and to establish a nomogram predictive model for forecasting therapeutic outcomes.Methods A retrospective study was conducted on 367 patients with progressive vitiligo admitted to Zhoukou Central Hospital from January 2023 to May 2024.All patients were treated with 308 nm excimer laser combined with Bailing tablets.After 12 weeks of treatment,they were divided into an effective group and an ineffective group based on efficacy.Clinical data of the two groups were compared,and multivariate logistic regression analysis was used to identify factors influencing the efficacy.A nomogram predictive model was constructed using R software,and its calibration,discriminative ability,and clinical utility were evaluated using calibration curves,receiver operating characteristic(ROC)curves,area under the curve(AUC),and decision curve analysis(DCA).Results Among the 367 patients,123 achieved complete recovery,120 showed significant improvement,56 had moderate improvement,and 68 were ineffective,yielding a total effective rate of 81.47%.Significant differences were observed between the two groups in terms of anxiety,sleep status,disease severity,course of disease,disease subtype,intestinal dysbiosis,albumin levels,free triiodothyronine(FT3),soluble programmed death-ligand 1(sPD-L1),and long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1(LncRNA MALAT1)expression(P<0.05).Multivariate logistic regression analysis revealed that anxiety,disease severity,course of disease,intestinal dysbiosis,sPD-L1,and LncRNA MALAT1 expression were risk factors negatively affecting efficacy(P<0.05),while albumin was a protective factor(P<0.05).The AUC of the nomogram predictive model was 0.875(95%CI:0.826-0.923),demonstrating high consistency between predicted and actual efficacy.Within a threshold probability range of 0-80%,the net benefit of the nomogram model was higher than both the "ALL" and "None" lines. Conclusion The predictive model based on anxiety, diseaseseverity, course of disease, intestinal dysbiosis, sPD-L1, LncRNA MALAT1 expression, and albumin is feasible and exhibitsgood predictive value, making it reliable for clinical application.
作者
刘静
刘宁
LIU Jing;LIU Ning(Department of Dermatology,Zhoukou Central Hospital,Zhoukou 466000,Henan,CHINA;Department of Pharmacy,Zhoukou Central Hospital,Zhoukou 466000,Henan,CHINA)
出处
《海南医学》
2025年第11期1563-1568,共6页
Hainan Medical Journal
基金
2023年医学科技攻关计划项目(编号:20230109)。
关键词
白癜风
白灵片
激光
疗效
列线图预测模型
进展期
Vitiligo
Bailing tablets
Laser
Efficacy
Nomogram predictive model
Progressive stage
