摘要
目的分析脑卒中后偏瘫患者上肢肌痉挛发生的危险因素及构建预测模型。方法选择2019年11月—2021年9月首都医科大学附属北京康复医院康复诊疗中心收治脑卒中后偏瘫患者82例作为研究对象,根据患者卒中后6个月是否发生上肢肌痉挛分为痉挛组32例和未痉挛组50例,统计2组患者的临床资料及痉挛程度,采用Logistic多因素回归分析脑卒中后偏瘫患者发生上肢肌痉挛的影响因素,并构建风险预测模型,采用Hosmer-Lemeshow检验评估模型拟合度,绘制受试者工作特征曲线(ROC)分析回归模型的预测价值。结果脑卒中后偏瘫患者82例,发生上肢肌痉挛32例(39.02%),其中改良Ashworth量表Ⅰ级17例(20.73%),Ⅰ^(+)级6例(7.32%),Ⅱ级5例(6.10%),Ⅲ级3例(3.66%),Ⅳ级1例(1.22%);未发生痉挛组50例(60.98%)。痉挛组患者的年龄≤40岁、糖尿病、脑出血、有躯体感觉障碍、心房颤动比例高于未痉挛组患者,差异均有统计学意义(P<0.05)。多因素Logistic分析显示,年龄≤40岁、糖尿病、脑出血、躯体感觉障碍、心房颤动均为影响脑卒中后偏瘫患者上肢肌痉挛的独立危险因素[OR(95%CI)=4.093(1.314~12.747)、4.071(1.292~12.830)、3.376(1.042~10.939)、3.614(1.204~10.848)、4.419(1.102~17.725)];构建脑卒中后偏瘫患者上肢肌痉挛的风险预测模型:P=1/[1+e^((-3.068+1.409×(年龄)+1.404×(糖尿病)+1.217×(脑出血)+1.285×(躯体感觉障碍)+1.486×(心房颤动)))],Hosmer-Lemeshow检验表明该模型预测值与实际观测值拟合度较好(χ^(2)=5.418,P=0.712),模型预测的AUC为0.811,95%CI为0.714~0.907,该模型具有较好的拟合度和预测效能。结论年龄≤40岁、糖尿病、脑出血、躯体感觉障碍、心房颤动均为影响脑卒中后偏瘫患者上肢肌痉挛的独立危险因素,临床可根据患者的高危因素进行早期干预,减少脑卒中后偏瘫患者上肢肌痉挛的发生率。
Objective To analyze the risk factors of upper limb muscle spasm in patients with post-stroke hemiplegia and to construct a predictive model.Methods A total of 82 patients with post-stroke hemiplegia who were admitted to the Rehabilitation and Diagnosis Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from November 2019 to September 2021 were selected as the research subjects.According to whether the patients had upper limb muscle spasm 6 months after the stroke,they were divided into a spastic group of 32 cases.The clinical data and spasticity of the patients in the two groups were counted.Logistic multivariate regression was used to analyze the influencing factors of upper limb muscle spasm in patients with post-stroke hemiplegia,and a risk prediction model was constructed,and the Hosmer Lemeshow test was used to evaluate the model.Fit,draw receiver operating characteristic curve(ROC)to analyze the predictive value of the regression model.Results Among 82 patients with post-stroke hemiplegia,32(39.02%)had upper limb muscle spasm,among which 17(20.73%)were grade Ⅰ,6(7.32%)were grade Ⅰ^(+),and 5(6.10%)were grade Ⅱ.),3 cases(3.66%)of grade Ⅲ,and 1 case of grade Ⅳ(1.22%).There were 50 cases(60.98%)in the no spasm group.The age of≤40 years old,diabetes,cerebral hemorrhage,somatosensory disorder and atrial fibrillation in the spastic group were higher than those in the non-spasmodic group,and the differences were statistically significant(P<0.05).Multivariate Logistic analysis showed that age≤40 years old,diabetes,cerebral hemorrhage,somatosensory disturbance,and atrial fibrillation were independent risk factors for upper limb muscle spasm in patients with post-stroke hemiplegia[OR(95%CI)=4.093(1.314-12.747),4.071(1.292-12.830),3.376(1.042-10.939),3.614(1.204-10.848),4.419(1.102-17.725)].Construct the risk prediction model of upper limb muscle spasm in hemiplegia patients after stroke:P=1/[1+e^((-3.068+1.409×(age)+1.404×(diabetes)+1.217×(cerebral hemorrhage)+1.285×(
作者
张珍
杨傲然
张晓颖
张巧荣
王丛笑
Zhang Zhen;Yang Aoran;Zhang Xiaoying;Zhang Qiaorong;Wang Congxiao(Rehabilitation Diagnosis and Treatment Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100043, China)
出处
《疑难病杂志》
CAS
2022年第6期604-608,共5页
Chinese Journal of Difficult and Complicated Cases
基金
国家重点研发计划项目(2020YFC2004303)
首都医科大学附属北京康复医院科研项目(2021-077)。
关键词
脑卒中
偏瘫
上肢肌痉挛
危险因素
预测模型
Stroke
Hemiplegia
Upper limb muscle spasm
Risk factor
Prediction model
