摘要
目的:探讨颈动脉狭窄斑块风险预测模型对觉醒型缺血性脑卒中静脉溶栓患者预后的评估价值。方法:选取94例接受静脉溶栓治疗的觉醒型缺血性脑卒中患者,依据预后将其分为预后不良组(26例)和预后良好组(68例),对其一般资料及颈动脉狭窄斑块超声因素行logistic回归分析,并构建风险预测模型。结果:单因素分析显示,预后不良组的年龄、合并冠心病、斑块形态、斑块表面光滑与否、狭窄程度、斑块长度、狭窄处峰值流速、RI与预后良好组相比,差异均有统计学意义(均P<0.05)。logistic多因素回归分析显示,合并冠心病、斑块形态不规则、斑块表面不光滑、重度狭窄、长斑块、狭窄处峰值流速高和RI大是觉醒型缺血性脑卒中患者静脉溶栓预后不良的独立危险因素(均P<0.05)。基于此建立预测模型,模型公式:Logit(P)=3.671×合并冠心病+3.726×斑块形态+3.827×斑块表面光滑+3.006×狭窄程度+0.383×斑块长度+3.796×狭窄处峰值流速+10.990×RI-34.572。其Hosmer-Lemeshow拟合优度检验显示,χ^(2)=1.700,P=0.989,AUC为0.958(P<0.001,95%CI 0.922~0.994),敏感度84.60%,特异度95.60%,最大约登指数为0.802,模型预测觉醒型缺血性脑卒中静脉溶栓患者预后不良的校正曲线总体趋势与理想曲线基本吻合。结论:觉醒型缺血性脑卒中患者在静脉溶栓治疗后颈动脉狭窄斑块的多项超声参数均有明显变化,基于此建立的超声参数风险预测模型对患者的预后具有一定的预测价值。
Objective:To explore the value of carotid artery stenosis plaque risk prediction model in evaluating the prognosis of intravenous thrombolysis in wake-up ischemic stroke.Methods:A total of 94 patients with wake-up ischemic stroke who received intravenous thrombolysis were selected.According to the prognosis of patients,they were divided into the poor prognosis group(26 cases)and the good prognosis group(68 cases).Logistic regression analysis was performed on the general clinical data and carotid artery stenosis plaque ultrasound factors of two groups,and a risk prediction model was constructed.Results:The single factor analysis showed that,the age,coronary heart disease history,plaque morphology,plaque surface,stenosis degree,plaque length,peak velocity at stenosis and RI in the poor prognosis group were significantly different from those in the good prognosis group(all P<0.05).Multiple logistic analysis showed that coronary heart disease history,irregular plaque morphology,unsmooth plaque surface,severe stenosis,long plaque,high peak velocity at stenosis and high RI were the independent risk factors for poor prognosis of intravenous thrombolysis in patients with wake-up ischemic stroke(all P<0.05).The risk prediction model formula was constructed with these factors,and the results of Hosmer-Lemeshow goodness-of-fit test showed thatχ^(2)=1.700,P=0.989,AUC was 0.958(P<0.001,95%CI 0.922~0.994),the sensitivity was 84.60%,the specificity was 95.60%,and the maximum Youden index was 0.802.The overall trend of the calibration curve of the risk prediction model to predict the poor prognosis was basically consistent with the ideal curve.Conclusions:Many ultrasonic parameters of carotid artery stenosis plaque in patients with wake-up ischemic stroke have changed significantly after intravenous thrombolysis.Based on this,the established ultrasonic parameter risk prediction model has certain predictive value for the prognosis of patients.
作者
吴浩堂
李晓莉
罗伟权
黄志勇
张岩
彭慧渊
WU Haotang;LI Xiaoli;LUO Weiquan;HUANG Zhiyong;ZHANG Yan;PENG Huiyuan(Department of Ultrasound,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China;Department of Emergency,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China;Department of Neurology,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China)
出处
《中国中西医结合影像学杂志》
2024年第6期682-686,714,共6页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
基金
广东省医学科学技术项目(B2023396)。
关键词
颈动脉狭窄斑块
超声检查
风险预测模型
觉醒型缺血性脑卒中
静脉溶栓
预后
Carotid artery stenosis plaque
Ultrasonography
Risk prediction model
Awakening ischemic stroke
Intravenous thrombolysis
Prognosis
