摘要
目的:探讨急性缺血性脑卒中(AIS)患者气虚证的影响因素,构建AIS患者气虚证的列线图预测模型。方法:纳入北京中医药大学东直门医院神经内科2019年1月-2020年1月收治的142例AIS患者,依据证候要素判断标准分为气虚组(47例)和非气虚组(95例),利用最小绝对收缩和选择算子(LASSO)方法筛选可能的影响因素,并将筛选的变量纳入多因素Logistic回归分析,构建AIS患者气虚证的列线图预测模型。基于Bootstrap法的内部验证法采用一致性系数(C-index)、校准曲线、决策曲线分析法(DCA)对模型的区分度、校准度和临床有效性进行评价。结果:性别、高血压病、脂蛋白a [LP(a)]、凝血酶原百分活动度(PT%)、载脂蛋白E(ApoE)表现型为AIS患者发生气虚证的独立影响因素(P<0.05)。利用上述指标构建列线图模型,C-index为0.733(95%CI[0.647,0.819]),该模型具有较好的精确度和区分度,内部验证C-index为0.691。校准曲线显示该模型的预测结果与实际结果具有较好的一致性。DCA曲线分析表明,当气虚证的可能性阈值率(Pt)>6%以及<93%时选择该列线图对AIS气虚证进行预测可临床获益。结论:本研究结合性别、高血压病、LP(a)、PT%、ApoE表现型5种独立影响因素,初步构建AIS患者气虚证的列线图预测模型。
Objective:To explore the influencing factors of qi deficiency syndrome in patients with acute ischemic stroke(AIS),and then constructing a nomogram model to predict qi deficiency syndrome in patients with AIS.Methods:The clinical data of 142 patients with AIS in the Department of Neurology,Dongzhimen Hospital,Beijing University of Chinese Medicine from January 2019 to January 2020 were collected and divided into the qi deficiency group(47 cases)and the nonqi deficiency group(95 cases)according to the criteria of syndrome factors.The LASSO regression model was used to optimize feature selection.Then the selected variables were included in multivariate logistic regression analysis to construct a nomogram prediction model for qi deficiency syndrome in patients with AIS.The performance of the nomogram was evaluated with respect to its calibration,discrimination and clinical utility using C-index,calibration curve and decision-making curve analysis,as well as bootstrapping for internal validation.Results:Gender,hypertension,LP(a),PT%,and apolipoprotein E phenotypes were independent factors of qi deficiency syndrome in patients with AIS(P<0.05).Using the above indicators to construct a nomogram model,the model has good discriminating ability.The C-index was 0.733(95%CI[0.647,0.819])and the model has good accuracy and crimination.The C-index of internal validation was 0.691.The calibration curve showed that the predicted results of the model were in good agreement with the actual results.The decision-making curve analysis indicated that the nomogram was clinically useful for predicting qi deficiency syndrome in the AIS patients at the possibility threshold>6%or<93%.Conclusion:A nomogram was preliminarily developed for predicting the risk of qi deficiency syndrome in patients with AIS with respect to the five independent influencing factors,including gender,hypertension,LP(a),PT%,and apolipoprotein E phenotypes.
作者
曹云
舒鑫
张丹莉
常静玲
CAO Yun;SHU Xin;ZHANG Dan-li;CHANG Jing-ling(Department of Ncurology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)
出处
《中华中医药杂志》
CAS
CSCD
北大核心
2021年第4期1939-1944,共6页
China Journal of Traditional Chinese Medicine and Pharmacy
基金
国家自然科学基金项目(No.81973790)
北京市自然科学基金项目(No.7181005)
中央高校基本科研业务费专项(No.2019-JYB-TD-003)。
关键词
急性缺血性脑卒中
气虚证
列线图
预测模型
Acute ischemic stroke
Qi deficiency syndrome
Nomogram
Prediction model
