生物反馈治疗盆底痉挛综合征患者疗效的列线图预测模型构建

doi:10.3969/j.issn.1006-5725.2026.07.015

Abstract

Abstract:

Objective To construct a prediction model based on clinical data， explore the factors influencing the efficacy of biofeedback treatment for spastic pelvic floor syndrome， and provide a basis for guiding individualized treatment through early identification of patients with poor treatment outcomes. Methods A total of 175 patients who underwent one course （10 sessions） of biofeedback treatment in the Department of Gastrointestinal Surgery， Third Hospital of Hebei Medical University， from June 2020 to June 2025， were selected for analysis. Clinical data before and after the treatment were collected. The dataset was partitioned into a training set （70%， n = 122） and a validation set （30%， n = 53）. Efficacy was defined as a reduction of over 50% in the ODS score and the normalization of the anorectal manometry defecation pattern. Based on the efficacy， patients were categorized into the treatment-effective group（TE） and treatment-ineffective group（TIE）. Feature variables were selected step-by-step through univariate logistic regression， Lasso regression， and multivariate logistic regression. A nomogram was constructed， and the discriminatory ability， calibration， fit， and clinical value of the model were evaluated using the receiver operating characteristic（ROC） curve， calibration curve， Hosmer-Lemeshow test， and decision curve analysis（DCA）. Results Multivariate logistic regression analysis revealed that anal resting pressure， digital evacuation， use of laxatives， use of enemas， sensation of incomplete evacuation， and patient satisfaction were independent risk factors influencing treatment efficacy. The area under the curve （AUC） values for the training and validation sets were 0.959 （95%CI： 0.921-0.996） and 0.971 （95%CI： 0.918-1.000）， respectively. The calibration curve indicated good calibration， and the Hosmer-Lemeshow test demonstrated no statistically significant difference between the actual and predicted probabilities in both the training and validation sets （P > 0.05）. DCA curves and 5-fold cross-validation suggested that the model provided clinical net benefits within a probability range of 0.1-0.8. Conclusions This study comprehensively integrates the clinical symptoms and diagnostic indicators of SPFS patients， thereby providing a reliable prediction model for the efficacy of BFT. This integration not only aids in the identification of high-risk patients but also offers valuable evidence for clinical decision-making.

Key words: biofeedback, spastic pelvic floor syndrome, outlet obstruction constipation, prediction model

CLC Number:

R657.1

Zefeng YUAN,Qiang CHEN,Ming LUO,Bo WANG,Bin KONG. Construction of a nomogram prediction model for the efficacy of biofeedback therapy in patients with spastic pelvic floor syndrome[J]. The Journal of Practical Medicine, 2026, 42(7): 1225-1234.

Figures/Tables 8

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项目	治疗前（n = 175）	治疗后（n = 175）	t值	P值
肛管静息压/mmHg	84.61 ± 19.87	65.81 ± 10.98	15.897	0.003
肛管长度/cm	4.76 ± 0.80	3.79 ± 0.47	19.088	< 0.001
缩榨压增量/mmHg	100.67 ± 35.42	68.72 ± 17.78	17.283	< 0.001
直肠推压/mmHg	62.26 ± 23.22	73.47 ± 16.27	-9.810	< 0.001
肛管松弛率/%	-0.33 ± 10.62	16.75 ± 5.52	-26.355	< 0.001
初始感觉阈值/mmHg	72.98 ± 19.83	57.71 ± 13.95	14.665	< 0.001
初始便意阈值/mmHg	108.90 ± 29.00	94.12 ± 20.57	12.905	< 0.001
最大耐受阈值/mmHg	164.77 ± 32.75	158.85 ± 23.87	4.453	< 0.001
ODS评分/分	23.15 ± 2.33	10.81 ± 2.27	62.346	< 0.001
排便时间/分	2.87 ± 0.71	1.55 ± 0.60	25.74	< 0.001
便意次数/分	2.58 ± 0.83	1.34 ± 0.63	23.344	< 0.001
手助排便/分	3.35 ± 0.63	1.63 ± 0.77	29.989	< 0.001
使用泻药/分	3.41 ± 0.62	1.30 ± 0.75	35.253	< 0.001
使用灌肠/分	2.22 ± 0.89	1.05 ± 0.64	18.050	< 0.001
排便不尽感/分	3.45 ± 0.67	1.42 ± 0.73	30.689	< 0.001
排便费力/分	3.60 ± 0.49	1.65 ± 0.63	38.368	< 0.001
粪便性状/分	1.66 ± 0.93	0.87 ± 0.62	12.299	< 0.001
PAC-QOL总分/分	60.86 ± 4.66	22.10 ± 3.94	102.196	< 0.001
躯体不适	10.21 ± 2.02	3.65 ± 1.30	53.540	< 0.001
心理不适	13.71 ± 2.48	4.65 ± 1.41	57.427	< 0.001
担心与焦虑	24.03 ± 2.93	9.57 ± 2.76	59.428	< 0.001
满意度	12.91 ± 1.68	4.23 ± 1.40	59.738	< 0.001

项目	TIE（n = 66）	TE（n = 109）	χ²/t/Z值	P值
性别/[例（%）]			0.644	0.422
男	27（45.1）	38（34.9）
女	39（54.9）	71（65.1）
年龄/岁	57.12 ± 14.06	56.15 ± 14.15	0.443	0.659
病程/年	12.38 ± 10.04	11.34 ± 7.30	0.732	0.466
BMI/（kg/m²）	22.12 ± 2.39	22.57 ± 2.15	-1.295	0.197
高血压/[例（%）]	30（45.5）	50（45.9）	0.003	0.957
糖尿病/[例（%）]	21（31.8）	38（34.9）	0.170	0.680
腹部手术史/[例（%）]	16（24.2）	31（26.3）	0.092	0.762
肛门手术史/[例（%）]	17（25.8）	27（25.0）	0.012	0.911
肛管静息压/mmHg	69.17 ± 12.63	63.78 ± 9.33	3.004	< 0.001
肛管长度/cm	3.92 ± 0.48	3.71 ± 0.45	2.933	0.004
缩榨压增量/mmHg	69.18 ± 16.41	68.44 ± 18.63	0.267	0.790
直肠推压/mmHg	71.32 ± 14.11	74.78 ± 17.38	-1.439	0.152
肛管松弛率/%	15.56 ± 5.77	17.47 ± 5.26	-2.242	0.026
初始感觉阈值/mmHg	61.26 ± 13.13	55.57 ± 14.05	2.660	0.009
初始便意阈值/mmHg	96.33 ± 20.50	92.78 ± 20.59	1.108	0.269
最大耐受阈值/mmHg	160.36 ± 21.59	157.94 ± 25.21	0.651	0.516
ODS总评分	12.91 ± 1.39	9.54 ± 1.68	14.340	< 0.001
排便时间	1.71 ± 0.55	1.46 ± 0.62	2.826	0.005
便意次数	1.41 ± 0.58	1.29 ± 0.66	1.176	0.241
手助排便	2.12 ± 0.60	1.33 ± 0.71	7.923	< 0.001
使用泻药	1.80 ± 0.66	1.00 ± 0.62	8.069	< 0.001
使用灌肠	1.35 ± 0.62	0.86 ± 0.59	5.210	< 0.001
排便不尽感	1.89 ± 0.64	1.13 ± 0.63	7.802	< 0.001
排便费力	1.73 ± 0.60	1.61 ± 0.65	1.235	0.218
粪便性状	0.89 ± 0.61	0.86 ± 0.63	0.325	0.746
PAC-QOL总评分	23.38 ± 3.53	21.32 ± 3.99	3.452	0.001
躯体不适	3.86 ± 1.31	3.52 ± 1.27	1.696	0.092
心理不适	4.71 ± 1.38	4.61 ± 1.43	0.442	0.659
担心与焦虑	9.77 ± 2.55	9.44 ± 2.89	0.770	0.442
满意度	5.03 ± 1.52	3.74 ± 1.07	6.042	< 0.001

变量	β	SE	Waldχ²	OR	95%CI	P值
肛门静息压	-0.05	0.02	5.95	0.95	0.92 ~ 0.99	0.015
肛管长度	-1.38	0.45	9.55	0.25	0.10 ~ 0.58	0.002
肛管松弛率	0.09	0.04	6.59	1.10	1.02 ~ 1.18	0.010
ODS总评分	-1.39	0.27	27.53	0.25	0.14 ~ 0.39	< 0.001
排便时间	-0.77	0.33	5.36	0.46	0.23 ~ 0.87	0.021
手助排便	-1.59	0.37	18.56	0.20	0.09 ~ 0.40	< 0.001
使用泻药	-1.92	0.38	25.67	0.15	0.07 ~ 0.29	< 0.001
使用灌肠	-1.17	0.35	10.95	0.31	0.15 ~ 0.60	0.001
排便不尽感	-1.89	0.38	24.96	0.15	0.07 ~ 0.30	< 0.001
满意度	-0.7	0.17	17.07	0.50	0.35 ~ 0.68	< 0.001

变量	β	SE	Wald χ²	OR	95% CI	P值
肛门静息压	-0.09	0.04	5.18	0.92	0.85 ~ 0.98	0.024
肛管长度	-0.89	0.70	1.63	0.41	0.10 ~ 1.55	0.201
肛管松弛率	0.01	0.07	0.01	1.00	0.88 ~ 1.15	0.955
排便时间	-1.03	0.63	2.72	0.36	0.09 ~ 1.15	0.099
手助排便	-1.79	0.65	7.57	0.17	0.04 ~ 0.52	0.006
排便不尽感	-2.19	0.72	9.23	0.11	0.02 ~ 0.39	0.002
使用泻药	-1.52	0.61	6.23	0.22	-0.06 ~ 0.67	0.013
使用灌肠	-1.59	2.35	4.12	0.20	0.04 ~ 0.80	0.042
满意度	-0.69	0.63	4.74	0.50	0.25 ~ 0.88	0.029

Construction of a nomogram prediction model for the efficacy of biofeedback therapy in patients with spastic pelvic floor syndrome

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[2]	Panpan GAO,Qian ZHANG,Tinghui LIU,Jie. SUN. Application of ipsilateral high⁃frequency rTMS combined with biofeedback⁃based air swallowing training in patients with post⁃stroke dysphagia [J]. The Journal of Practical Medicine, 2025, 41(8): 1105-1110.
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[4]	Zhaoyang WANG,Nan. ZHANG. Constructing a Nomogram prediction model for early recurrence of hepatocellular carcinoma radical hepatectomy based on CT imaging omics and traditional Chinese medicine tongue image features [J]. The Journal of Practical Medicine, 2025, 41(16): 2590-2596.
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