摘要
目的构建预测行血管内介入治疗的急性脑梗死患者预后不良的列线图模型,探讨其在预后评估中的价值。方法2020年3月—2023年3月南阳市中心医院诊治急性脑梗死患者167例,均行血管内介入治疗,术后3个月采用改良Rankin量表评分(mRS)评估患者预后,其中mRS<3分者66例为预后良好组,mRS≥3分者101例为预后不良组。比较2组年龄、术后并发症、术后24 h美国国立卫生研究院卒中量表(NIHSS)评分及术后纤维蛋白原/白蛋白比值(FAR)、血管内皮生长因子(VEGF)、D-二聚体水平等临床资料。采用多因素logistic回归分析行血管内介入治疗的急性脑梗死患者预后不良的影响因素;根据影响因素构建预测行血管内介入治疗的急性脑梗死患者预后不良的列线图模型。绘制校准曲线,采用Hosmer-Lemeshow拟合优度检验评价模型的校准度;绘制ROC曲线,评估模型的预测效能;采用一致性指数评估模型的区分度,采用Bootstrap法进行内部验证。结果167例患者预后不良发生率为60.48%。预后不良组年龄≥60岁、术后严重脑水肿、出血转化比率(73.27%、58.42%、49.50%),术后24 h NIHSS评分[(19.42±3.24)分]、FAR(0.09±0.02)及VEGF[(351.49±30.75)ng/L]、D-二聚体[(448.75±46.75)μg/L]水平均高于预后良好组[42.42%、18.18%、30.30%、(11.24±2.75)分、0.07±0.01、(256.54±21.38)ng/L、(226.74±15.76)μg/L](χ^(2)=15.973、24.439、6.045,t=16.909、7.527、21.859、37.190;P均<0.05)。年龄(OR=3.374,95%CI:1.620~5.127,P<0.001)、术后24 h NIHSS评分(OR=3.747,95%CI:1.456~6.038,P<0.001)、术后严重脑水肿(OR=4.963,95%CI:2.581~7.345,P<0.001)、FAR(OR=2.707,95%CI:1.100~4.315,P<0.001)、VEGF(OR=4.242,95%CI:2.276~6.028,P<0.001)、D-二聚体(OR=5.948,95%CI:3.383~8.512,P<0.001)是行血管内介入治疗的急性脑梗死患者预后不良的影响因素。列线图模型的校准曲线接近理想曲线,拟合良好(χ^(2)=3.526,P=0.752)。列线图模型预测行血管内介入治疗的�
Objective To construct a nomogram model to predict the poor prognosis of patients with acute cerebral infarction after endovascular intervention,and to investigate its predictive value.Methods A total of 167 patients with acute cerebral infarction received endovascular intervention in Nanyang Central Hospital from March 2020 to March 2023,and were divided into 66 patients with modified Rankin scale(mRS)<3(good prognosis group)and 101 patients with mRS≥3(poor prognosis group)according to the prognosis 3 months after operation.The clinical data as age,postoperative complications,National Institutes of Health Stroke Scale(NIHSS)score 24 h postoperatively,fibrinogen to albumin ratio(FAR),vascular endothelial growth factor(VEGF),and D-dimer level were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of poor prognosis in patients with acute cerebral infarction after endovascular interventional therapy.A nomogram model was constructed based on these influencing factors to predict the poor prognosis.The calibration curve was drawn,and the Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration degree of the model.ROC curve was drawn to evaluate the predictive efficiency of the model.Consistency index was used to evaluate the differentiation of the model,and Bootstrap method was used for internal verification.Results The poor prognosis rate of 167 patients was 60.48%.The proportions of patients aged≥60 years old,postoperative severe cerebral edema and hemorrhagic conversion,NIHSS score 24 h postoperatively,FAR,and levels of VEGF and D-dimer were higher in poor prognosis group[73.27%,58.42%,49.50%,19.42±3.24,0.09±0.02,(351.49±30.75)ng/L,(448.75±46.75)μg/L]than those in good prognosis group[42.42%,18.18%,30.30%,11.24±2.75,0.07±0.01,(256.54±21.38)ng/L,(226.74±15.76)μg/L](χ^(2)=15.973,χ^(2)=24.439,χ^(2)=6.045,t=16.909,t=7.527,t=21.859,t=37.190;allP values<0.05).Age(OR=3.374,95%CI:1.620-5.127,P<0.001);NIHSS score 24 h postoperatively(OR=
作者
曾庆
孙军
温昌明
ZENG Qing;SUN Jun;WEN Changming(Department of Interventional Radiology,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《中华实用诊断与治疗杂志》
2024年第8期822-827,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划联合共建项目(192102310349)。
关键词
急性脑梗死
血管内介入治疗
预后不良
列线图
acute cerebral infarction
endovascular intervention
poor prognosis
nomogram
