目的 探讨点阵CO2激光治疗痤疮瘢痕效果的影响因素,并构建疗效的预测模型.方法 回顾性分析2020年5月至2023年7月,行点阵CO2激光治疗痤疮瘢痕患者291例的临床资料,作为建模集,并依据激光治疗后的临床疗效结果分成有效组(n=239)和无效组(n=52).比较两组患者基础资料、瘢痕相关资料、是否存在其他皮肤疾病、情绪状态,通过多因素分析确定影响疗效的因素.应用R软件中的rms包构建预测模型,并对其预测效能予以内部验证.另选取68例痤疮瘢痕患者作为验证集并对模型开展外部验证.结果 两组患者年龄、皮肤类型、瘢痕严重程度、瘢痕最大径、伴有其他皮肤疾病及存在不良情绪情况比较,差异具有统计学意义(P<0.05).Logistic回归分析显示,痤疮瘢痕疗效的影响因素主要有年龄、皮肤类型、瘢痕严重程度、伴有其他皮肤疾病、存在不良情绪等5项;依据上述5项因素构建预测模型并行内部验证,结果显示ROC曲线下面积(area under curve,AUC)为0.796(95%CI:0.667~0.914),校准曲线拟合较佳,HL检验x2=6.736,P=0.565.外部验证显示,68例患者有效率为80.9%,无效率为 19.1%,AUC为0.807(95%CI:0.751~0.863),HL检验x2=7.126,P=0.459.结论 患者年龄大、皮肤类型为干性、瘢痕程度为重度、伴有其他皮肤疾病、存在不良情绪为点阵CO2激光治疗痤疮瘢痕效果的危险因素,据此建立的列线图模型对患者疗效具有较好的预测作用.
Analysis on Influencing Factors and Construction of Predictive Models for Efficacy of Dot Matrix CO2 Laser Treatment for Acne Scars
Objective To explore the influencing factors of the efficacy of dot matrix CO2 laser in treating acne scars and construct a predictive model for the efficacy.Methods The clinical data of 291 patients with acne scars treated with dot matrix CO2 laser over the period from May.2020 to Jul.2023 were retrospectively analyzed.Being a modeling set as a whole,the patients were divided into an effective group(n=239)and ineffective group(n=52)according to the clinical efficacy results after the laser treatment.The basic data,scar related data,presence of other skin diseases and emotional state of the patients in two groups were compared,and the factors affecting the curative effect were determined via multi-factor analysis.The rms package in R software was used to construct the prediction model,and its prediction efficiency was verified internally.Other 68 patients with acne scars were selected to compose a validation set,and the model was externally verified.Results There were apparent differences between the effective group and ineffective group in terms of age,skin type,severity of scars,maximum diameter of scars and presence of other skin diseases and adverse emotions(P<0.05).It was shown by Logistic regression analysis that the main influencing factors for the treating efficacy of acne scars included age,skin type,severity of scars and presence of other skin diseases and negative emotions.With these factors,a prediction model was constructed and validated internally.The results of the validation showed that the area under the ROC curve(AUC)was 0.796(95%CI:0.667~0.914),the calibration curve fitted well and the HL test showed x2=6.736,P=0.565.External verification showed that the effective rate of the 68 patients was 80.9%,inefficiency was 19.1%,AUC was 0.807(95%CI:0.751~0.863),HL test showed x2=7.126,P=0.459Conclusions Age,dry skin,severe scar degree,accompanying by other skin diseases and presence of negative emotions are risk factors for the efficacy of dot matrix CO2 laser treatment for acne scars.The column chart model established based on this has a good predictive effect on the efficacy.
LaserAcne scarsInfluencing factorsPrediction model