摘要
目的分析急性缺血性脑卒中患者经阿替普酶静脉溶栓治疗后预后不良的危险因素,并构建列线图风险预测模型。方法纳入368例接受阿替普酶静脉溶栓治疗的急性缺血性脑卒中患者,于治疗后3个月采用改良Rankin量表评价患者的预后情况。比较不同预后患者的一般资料和临床资料,采用Logistic回归模型分析患者经阿替普酶静脉溶栓治疗后预后不良的危险因素。将回归分析中具有统计学意义(P<0.05)的变量作为预测因子,建立急性缺血性脑卒中患者经阿替普酶静脉溶栓治疗后预后不良的列线图风险预测模型,并对模型进行验证。结果368例患者经阿替普酶静脉溶栓治疗后3个月,有104例(28.26%)预后不良。不同预后患者的高血压合并情况、糖尿病合并情况、溶栓时间(即发病至给予溶栓药物的时间)、大面积脑梗死发生率、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、入院时白细胞计数和C-反应蛋白(CRP)水平比较,差异均具有统计学意义(均P<0.05)。合并高血压、大面积脑梗死、溶栓时间长、溶栓前NIHSS评分高、入院时白细胞计数和CRP水平升高均为缺血性脑卒中患者经阿替普酶静脉溶栓治疗预后不良的危险因素(均P<0.05)。列线图风险预测模型的曲线下面积为0.907,灵敏度为0.865,特异度为0.837;Hosmer-Lemeshow检验结果为χ2=8.589,P=0.378;校准曲线显示该列线图模型内部验证前后的平均绝对误差为0.014。结论高血压、大面积脑梗死、溶栓时间长、溶栓前NIHSS评分高、入院白细胞计数及血清CRP水平高的急性缺血性脑卒中患者在阿替普酶静脉溶栓治疗后出现预后不良的风险增加。基于上述危险因素建立的列线图风险预测模型具有良好的区分度、校准度及预测一致性,简单易懂,或可为临床医生制订溶栓前后的决策提供参考。
Objective To analyze the risk factors foRadverse prognosis of patients with acute ischemic cerebral stroke afteRintravenous thrombolytic therapy with alteplase,and to construct the Nomogram risk prediction model.Methods A total of 368 patients with acute ischemic cerebral stroke receiving intravenous thrombolytic therapy with alteplase were enrolled,and theiRprognoses afteR3 months of treatment were evaluated by the modified Rankin scale.The general and clinical data were compared between the patients with different prognoses,and the risk factors foRadverse prognosis of patients afteRintravenous thrombolytic therapy with alteplase were analyzed using the Logistic regression model.The variables with statistical significance(P<0.05)of the regression analysis were used as predictors to construct a Nomogram risk prediction model foRadverse prognosis of patients with acute ischemic stroke afteRintravenous thrombolytic therapy with alteplase,and the model was verified.Results AfteR3 months of intravenous thrombolytic therapy with alteplase,104(28.26%)of 368 patients had adverse prognoses.There were statistically significant differences in the conditions of concomitant hypertension and diabetes mellitus,and thrombolytic time(i.e.time between onset and administration of thrombolytic drugs),incidence rate of large cerebral infarction,pre-thrombolytic National Institutes of Health Stroke Scale(NIHSS)score,as well as white blood cell count and C-reactive protein(CRP)level on admission between the patients with different prognoses(all P<0.05).Concomitant hypertension,large cerebral infarction,long length of thrombolysis,high pre-thrombolytic NIHSS score,and elevated white blood cell count and CRP level on admission were the risk factors foRadverse prognosis of patients with acute ischemic cerebral stroke afteRintravenous thrombolytic therapy with alteplase(all P<0.05).The area undeRthe curve of the Nomogram risk prediction model was 0.907,the sensitivity was 0.865,and the specificity was 0.837.The result of Hosmer-Lemeshow e
作者
劳小平
罗世旺
张炜志
廖荣西
李雄新
LAO Xiao-ping;LUO Shi-wang;ZHANG Wei-zhi;LIAO Rong-xi;LI Xiong-xin(Department of Neurology,Beihai People′s Hospital,Beihai 536000,Guangxi,China;Department of Neurology,Qinzhou First People′s Hospital,Qinzhou 535000,Guangxi,China)
出处
《广西医学》
CAS
2022年第21期2493-2497,2503,共6页
Guangxi Medical Journal
基金
广西北海市科技计划项目(北科合20210103Z)。
