摘要
目的探讨血清尿酸、神经元特异性烯醇化酶(NSE)、同型半胱氨酸(Hcy)水平与脑梗死患者预后的关系,并以此建立预测脑梗死患者预后不良的列线图模型。方法回顾性分析2018年1月~2020年7月在保定市第二医院老年病科住院的1458例脑梗死患者,采用改良的Rankin量表(mRS)评估患者出院3个月后预后情况,并分为预后良好组(mRS评分<3分,1186例)和预后不良组(mRS评分≥3分,272例)。比较2组患者一般资料,有统计学差异的指标用于多因素logistic回归分析,并将其确定的独立危险因素纳入R3.6.3软件,用rms程序包绘制预测脑梗死患者预后不良的列线图;采用校准曲线及ROC曲线下面积判断预测模型的效果。结果脑梗死患者预后良好者为81.34%,预后不良者为18.66%。预后不良组年龄、梗死体积、美国国立卫生研究院卒中量表(NIHSS)评分、高敏C反应蛋白(hs-CRP)、D-二聚体、尿酸、NSE及Hcy水平均明显高于预后良好组(P<0.01)。年龄(OR=1.019,95%CI:1.005~1.033)、梗死体积(OR=1.015,95%CI:1.006~1.024)、NIHSS评分(OR=1.057,95%CI:1.012~1.105)、hs-CRP(OR=1.051,95%CI:1.007~1.097)、D-二聚体(OR=2.506,95%CI:1.607~3.908)、尿酸(OR=1.003,95%CI:1.001~1.005)、NSE(OR=1.024,95%CI:1.006~1.042)及Hcy水平(OR=1.037,95%CI:1.011~1.064)均是影响脑梗死患者预后不良的危险因素(P<0.05,P<0.01)。校准曲线斜率接近1,ROC曲线下面积为0.725(95%CI:0.690~0.761),且Hosmer-Lemeshow拟合优度检验χ^(2)=7.570,P=0.477。结论本研究基于血清尿酸、NSE、Hcy水平等建立的预测脑梗死患者预后不良的列线图模型,可有效鉴别预后不良发生的高危人群。
Objective To establish the nomogram model for predicting the poor outcome in cerebral infarction patients by studying the relationship of serum levels of UA,neuron-specific enolase(NSE)and homocysteine(Hcy)with the outcome in cerebral infarction patients.Methods A total of 1458 cerebral infarction patients admitted to Baoding No.2 hospital from January 2018 to July 2020 were divided into good outcome group(n=1186)and poor outcome group(n=272)according to their mRS score.Their general clinical data were recorded and analyzed by multivariate logistic regression analysis.The independent risk factors for cerebral infarction were analyzed by R3.6.3 software.The nomogram model for predicting the poor outcome in cerebral infarction patients was established with rms program package.The efficiency of nomogram model for predicting the poor outcome in cerebral infarction patients was assessed according to its adjusted curve and AUC.Results The outcome was good in 81.34%cerebral stroke patients and poor in 18.66%cerebral stroke patients.The age was significantly older,the infarction size was significantly larger,the NIHSS score and serum levels of hs-CRP,D-dimer,UA,NSE and Hcy were significant higher in poor outcome group than in good outcome group(P<0.01).Age,infarction size,NIHSS score,serum levels of hs-CRP,D-dimer,UA,NSE and Hcy were risk factors for the poor outcome in cerebral infarction patients(OR=1.019,95%CI:1.005-1.033,OR=1.015,95%CI:1.006-1.024,OR=1.057,95%CI:1.012-1.105,OR=1.051,95%CI:1.007-1.097,OR=2.506,95%CI:1.607-3.908,OR=1.003,95%CI:1.001-1.005,OR=1.024,95%CI:1.006-1.042,OR=1.037,95%CI:1.011-1.064,P<0.05,P<0.01).The calibrated slope curve was close to 1.The AUC of nomogram model for predicting the poor outcome in cerebral infarction patients was 0.725(95%CI:0.690-0.761)with χ^(2)=7.570,P=0.477 detected in Hosmer-Lemeshow goodness-of-fit test.Conclusion The nomogram model for predicting the poor out-come in cerebral infarction patients established according to the serum levels of UA,NSE and Hcy can effective
作者
臧艳静
郑宏伟
崔泽岩
Zang Yanjing;Zheng Hongwei;Cui Zeyan(Department of Geriatrics,Baoding No.2 Hospital,Baoding 071000,Hebei Province,China)
出处
《中华老年心脑血管病杂志》
北大核心
2022年第3期277-280,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
保定市科技计划项目(1941ZF008)。
