摘要
目的 探讨颈动脉斑块患者发生前循环缺血性卒中的临床及多模态超声(multimodal ultrasound,MMU)影响因素,构建基于超微血流成像技术(superb microvascular imaging,SMI)的风险分层预测模型。方法 回顾性分析颈动脉斑块患者683例,根据临床表现和多层螺旋电子计算机断层扫描(computed tomography,CT)/核磁共振扫描(magnetic resonance imaging,MRI),分为前循环卒中组(n=301)和非前循环卒中组(n=382)。收集患者颈动脉斑块的MMU特征、临床和实验室检查数据,采用多因素二元Logistic回归分析筛选出前循环缺血性卒中的影响因素。构建列线图风险预测模型,进行模型验证与风险分层。结果 前循环卒中组和非前循环卒中组年龄、体重指数(body mass index,BMI)、饮酒史、吸烟史、脑梗死既往史、高血压、糖尿病、低密度脂蛋白(low-density lipoprotein,LDL)、高密度脂蛋白(high-density lipoprotein,HDL)、同型半胱氨酸(homocysteine,HCY)、颈动脉狭窄、斑块表面形态、斑块内新生血管差异有统计学意义(P<0.05)。多因素二元Logistic回归分析结果显示,年龄、BMI、吸烟史、脑梗既往史、糖尿病、高血压、LDL、HCY、多模态超声特征(颈动脉狭窄、斑块表面形态、斑块内新生血管)是颈动脉斑块患者发生前循环缺血性卒中的独立危险因素(P<0.05)。基于上述11个指标构建了个体化预测前循环卒中发生风险的列线图模型,所得列线图总分数能更有效地预测合并颈动脉斑块者发生前循环卒中的风险(AUC:0.781,95%CI:0.747~0.816,Hosmer-Lemeshow P=0.637)。该模型的最优截断值0.465(列线图得分138分)将颈动脉斑块患者分为低风险和高风险亚组。Bootstrap验证法证明该模型临床性能良好。结论 MMU构建的风险预测模型能方便、快捷、较准确地预测颈动脉斑块患者前循环卒中的发生并进行风险分层。
Objective To explore influencing factors of anterior circulation ischemic stroke in patients with carotid plaque by the clinical and multimodal ultrasound(MMU),and to construct a risk stratification prediction model based on superb microvascular imaging(SMI).Methods A total of 683 patients with carotid plaque were retrospectively analyzed.They were assigned to anterior circulation stroke group(n=301)and non-anterior circulation stroke group(n=382)based on clinical presentation and computed tomography(CT)/magnetic resonance imaging(MRI).MMU characteristics of carotid plaques,and clinical and laboratory examination data were collected.Multivariate binary Logistic regression analysis was used to screen the influencing factors of anterior circulation stroke.The nomogram prediction model was constructed,to carry out model verification and risk stratification.Results There were statistically significant differences in age,body mass index(BMI),drinking history,smoking history,previous history of cerebral infarction,hypertension,diabetes,low-density lipoprotein(LDL),high-density lipoprotein(HDL),homocysteine(HCY),carotid stenosis,plaque surface morphology and intraplaque neovascularization between anterior circulation stroke group and non-anterior circulation stroke group(P<0.05).Multivariate binary Logistic regression analysis found that age,BMI,smoking history,drinking history,previous history of cerebral infarction,diabetes,LDL,HCY and MMU(carotid stenosis,plaque surface morphology,intraplaque neovascularization)were independent risk factors for anterior circulation stroke in patients with carotid plaque(P<0.05).Based on the above 11 indicators,the individualized nomogram prediction model of anterior circulation stroke was constructed.The total score of the obtained nomogram could more effectively predict the risk of anterior circulation stroke in patients with carotid plaque(AUC:0.781,95%CI:0.747-0.816,Hosmer-lemeshow P=0.637).The optimal cutoff value of the model was determined to be 0.465(the nomogram score:138),wh
作者
高亚飞
王华
褚雯
寇育红
GAO Ya-fei;WANG Hua;CHU Wen;KOU Yu-hong(Division of Graduate,Xinxiang Medical University,He′nan Province,Xinxiang 453003,China;Department of Ultrasonography,Luoyang Central Hospital,He′nan Province,Luoyang 471000,China)
出处
《河北医科大学学报》
CAS
2023年第4期465-471,共7页
Journal of Hebei Medical University
基金
河南省科技发展计划项目(202102310440)
河南省科技攻关联合共建项目(LHGJ20200869,LHGH20210863)
洛阳市科技攻关重点项目(2101032A)。
关键词
缺血性卒中
颈动脉狭窄
多模态超声
ischemic stroke
carotid stenosis
multimodal ultrasound
