目的:分析慢性根尖周炎(chronic apical periodontitis,CAP)患者行根管治疗预后影响因素,并构建列线图预测模型.方法:选择2019年1月～2020年8月我院收治的227例CAP患者,均行根管治疗,术后开展为期3年的随访,依据CAP患者行根管治疗术后根尖愈合情况分为未愈合组(n=44)与愈合组(n=183),Logistic回归分析筛选影响CAP患者术后根尖未愈合的危险因素;R软件构建预测CAP患者术后根尖未愈合的列线图模型,列线图模型构建后用ROC曲线、校准曲线、Hosmer-Lemeshow拟合优度检验进行评估.结果:227例CAP患者中44例(19.38％)术后根尖未愈合、183例(80.62％)术后根尖愈合.Logistic回归分析结果显示,牙位(后牙)(95％CI 3.479～24.291,P＜0.001)、再治疗(95％CI 2.681～16.874,P＜0.001)、继发龋(95％CI 2.328～17.631,P＜0.001)、冠渗漏(95％CI 1.625～8.826,P=0.002)、器械折断(95％CI2.466～18.674,P＜0.001)是 CAP 患者术后根尖未愈合的独立危险因素.ROC曲线下面积0.856(95％CI0.801～0.911).校准曲线斜率接近1,且Hosmer-Lemeshow拟合优度检验x2=8.231,P=0.313.结论:影响CAP患者行根管治疗预后的因素很多,术后根尖未愈合与牙位(后牙)、再治疗、继发龋、冠渗漏、器械折断有关,基于以上5项独立危险因素构建的列线图模型对CAP患者行根管治疗术后根尖未愈合有较好的预测价值.
Analysis of factors affecting the prognosis of chronic apical periodontitis patients undergoing root canal therapy and construction of a column chart prediction model
Objective:To analyze the prognostic factors of chronic apical periodontitis(CAP)patients undergoing root canal therapy and construct a column chart prediction model.Methods:From January 2019 to August 2020,227 patients with CAP admitted to our hospital were collected,all of whom underwent root canal therapy.A 3-year follow-up was conducted af-ter the surgery.Based on the healing status of the root apex of CAP patients after root canal therapy,they were separated into the non healing group(n=44)and the healing group(n=183).Logistic regression analysis was applied to screen for risk fac-tors affecting postoperative apical non healing in CAP patients.R software was applied to construct a column chart model for predicting postoperative apical non healing in CAP patients,after constructing the column chart model,the ROC curve,cali-bration curve,and Hosmer Limeshow goodness of fit test were applied for evaluation.Results:Among the 227 CAP patients,44 cases(19.38％)had postoperative apical non healing,and 183 cases(80.62％)had postoperative apical healing.The re-sults of Logistic regression analysis showed that the posterior tooth position(95％CI 3.479～24.291,P＜0.001),retreatment(95％CI 2.681～16.874,P＜0.001),secondary caries(95％CI 2.328～17.631,P＜0.001),crown leakage(95％CI 1.625～8.826,P=0.002),and instrument fracture(95％CI 2.466～18.674,P＜0.001)were independent risk factors for postopera-tive apical non healing in CAP patients.The area under the ROC curve was 0.856(95％CI 0.801～0.911).The slope of the calibration curve was close to 1,and the Hosmer-Lemeshow goodness of fit test x2=8.231,P=0.313.Conclusion:There are many factors that affect the prognosis of root canal therapy in CAP patients.Postoperative apical non healing is related to pos-terior tooth position,retreatment,secondary caries,crown leakage,and instrument fracture.This study constructs a column chart model based on the above five independent risk factors,which has good predictive value for apical non healing in CAP patients after root canal therapy.
Chronic apical periodontitisRoot canalPrognosisInfluencing factorsColumn chart prediction model
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