良性阵发性位置性眩晕复发风险预测模型的构建

文献信息

中文摘要

目的： 探讨良性阵发性位置性眩晕（BPPV）患者复发的相关因素，构建复发风险预测模型，并进一步评估前庭诱发肌源性电位（VEMP）参数在提高模型预测性能方面的增量价值。
方法： 在这项回顾性研究中，纳入2022年1月至2024年12月期间在厦门市海沧医院接受标准化耳石复位手法治疗的BPPV患者。提取人口学数据、合并症、焦虑自评量表（SAS）评分、匹兹堡睡眠质量指数（PSQI）评分、VEMP参数及随访信息。进行单因素和多因素logistic回归分析以确定与复发相关的因素，并据此构建复发预测模型。采用受试者工作特征（ROC）曲线分析、受试者工作特征曲线下面积（AUC）、偏倚校正校准曲线、Hosmer-Lemeshow拟合优度检验和决策曲线分析（DCA）评估模型的区分度、校准度和临床实用性。
结果： 共纳入257例BPPV患者，其中64例（24.9%）在随访期间出现复发。多因素logistic回归分析确定糖尿病、高血压、眼性前庭诱发肌源性电位（oVEMP）异常、PSQI评分和SAS评分为BPPV复发的独立相关因素。纳入这些变量的模型显示出良好的区分度，AUC为0.796（95% CI，0.734-0.857），显著高于未纳入oVEMP异常的模型（AUC = 0.736；95% CI，0.669-0.804；P = 0.021）。根据Hosmer-Lemeshow检验，该模型显示出良好的校准度（P = 0.270）。DCA表明在0.20至0.60的阈值概率范围内具有有利的净获益。使用bootstrap重采样进行内部验证，得到乐观校正后的AUC为0.777（95% CI，0.722-0.843）。
结论： 糖尿病、高血压、PSQI评分、SAS评分和oVEMP异常与BPPV复发相关。由这些因素构建的预测模型表现出良好的区分度和校准度。该模型可能有助于对BPPV患者进行风险分层并为个体化管理考虑提供信息。

英文摘要

OBJECTIVE: To investigate factors associated with recurrence in patients with benign paroxysmal positional vertigo (BPPV), develop a recurrence risk prediction model, and further evaluate the incremental value of vestibular evoked myogenic potential (VEMP) parameters in improving model predictive performance.
METHODS: In this retrospective study, patients with BPPV treated with standardized canalith repositioning maneuvers at Haicang Hospital of Xiamen between January 2022 and December 2024 were included. Demographic data, comorbidities, self-rating anxiety scale (SAS) scores, pittsburgh sleep quality index (PSQI) scores, VEMP parameters, and follow-up information were extracted. Univariable and multivariable logistic regression analyses were conducted to determine factors associated with recurrence, and a recurrence prediction model was developed accordingly. Model discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curve analysis, area under the receiver operating characteristic curve (AUC), bias-corrected calibration curves, the Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA).
RESULTS: A total of 257 patients with BPPV were included, of whom 64 (24.9%) experienced recurrence during follow-up. Multivariable logistic regression analysis identified diabetes mellitus, hypertension, abnormal ocular vestibular evoked myogenic potential (oVEMP), PSQI score, and SAS score as independent factors associated with BPPV recurrence. The model incorporating these variables showed good discrimination, with an AUC of 0.796 (95% CI, 0.734-0.857), which was significantly higher than that of the model excluding oVEMP abnormality (AUC = 0.736; 95% CI, 0.669-0.804; P = 0.021). The model demonstrated good calibration according to the Hosmer-Lemeshow test (P = 0.270). DCA indicated a favorable net benefit across threshold probabilities ranging from 0.20 to 0.60. Internal validation using bootstrap resampling yielded an optimism-corrected AUC of 0.777 (95% CI, 0.722-0.843).
CONCLUSION: Diabetes mellitus, hypertension, PSQI score, SAS score, and abnormal oVEMP are associated with the recurrence of BPPV. The prediction model developed from these factors exhibited good discrimination and calibration. This model may facilitate risk‑stratification and inform individualized management considerations for patients with BPPV.