急性缺血性脑卒中静脉溶栓后血管再闭塞预测模型构建及评价

王玉; 刘才丹; 周运波; 张慧; 罗焕文

doi:10.16766/j.cnki.issn.1674-4152.003577

急性缺血性脑卒中静脉溶栓后血管再闭塞预测模型构建及评价

doi: 10.16766/j.cnki.issn.1674-4152.003577

湖南中医药大学第一附属医院神经内科, 湖南长沙 410007

基金项目:

湖南省卫生健康委科研课题 202011000475

详细信息

通讯作者:
王玉，E-mail：wangyu1354@126.com

中图分类号: R743.3
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出版历程
- 收稿日期: 2023-10-17
- 网络出版日期: 2024-09-05

Construction and evaluation the prediction model of vascular reocclusion after intravenous thrombolysis in acute ischemic stroke

Department of Neurology, the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan 410007, China

摘要

摘要: 目的建立急性缺血性脑卒中(AIS)静脉溶栓治疗后血管再闭塞的列线图预测模型，并进行初步验证。方法回顾性分析2020年1月—2023年6月在湖南中医药大学第一附属医院接受静脉溶栓治疗的316例AIS患者的临床资料，根据静脉溶栓后血管再闭塞情况分为无闭塞组(264例)和再闭塞组(52例)。比较2组临床特征差异，采用多因素logistic回归分析研究血管再闭塞的影响因素并建立列线图模型，采用ROC曲线和校准曲线评估模型的区分度和校准度，同时进行临床决策曲线分析。结果经单因素分析和多因素logistic回归分析显示，有房颤史、基线美国国立卫生研究院卒中量表(NIHSS)评分高、发病到治疗时间延长是AIS患者静脉溶栓治疗后血管再闭塞的危险因素，而应用替罗非班则是保护因素(P < 0.05)。构建的列线图模型的ROC曲线下面积(95% CI)为0.768(0.701~0.835)。校准曲线显示，模型预测血管再闭塞的预测和实际发生概率有较好的一致性(Hosmer-Lemeshow χ²=8.246，P=0.410)，当利用本模型预测AIS患者溶栓后血管再闭塞风险>0.15时，采取相应的干预措施，可使患者有较好的临床获益。结论 AIS患者静脉溶栓治疗后血管再闭塞的影响因素较多，合理构建的列线图模型具有较好的区分度和准确度，可用于患者的风险分层。
- 急性缺血性脑卒中 /
- 静脉溶栓 /
- 血管再闭塞 /
- 影响因素
Abstract: Objective To establish and validate a nomogram prediction model for vessel re-occlusion after intravenous thrombolysis in acute ischaemic stroke (AIS). Methods A total of 316 patients with AIS who received intravenous thrombolysis at the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2020 to June 2023 were retrospectively analyzed, and divided into non-occlusion group (264 cases) and re-occlusion group (52 cases) according to the status of re-occlusion after intravenous thrombolysis. The differences in clinical characteristics between the two groups were compared, factors affecting vessel re-occlusion were analyzed by multivariate logistic regression and a nomogram model was created. The degree of discrimination and calibration of the model was assessed by using receiver operating characteristic (ROC) and calibration curves, and the clinical decision curve was analyzed. Results Univariate and multivariate logistic regression analysis showed that history of atrial fibrillation, high baseline National Institutes of Health Stroke Scale (NIHSS) score and longer time from onset to treatment were risk factors for re-occlusion after intravenous thrombolysis in AIS patients, whereas Tirofiban was protective factor (P < 0.05). The area under ROC curve (AUC) of the constructed nomogram model was 0.768 (0.701-0.835). The calibration curve showed that there was good agreement between the prediction of vessel reocclusion by the model and the actual probability of occurrence (Hosmer-Lemeshow χ²=8.246, P=0.410). If the risk of vessel re-occlusion after thrombolysis in AIS patients is predicted to be >0.15 using this model, appropriate interventional measures should be taken. It can make patients get better clinical benefit. Conclusion There are many factors that influence vessel re-occlusion after intravenous thrombolytic therapy in AIS patients, and the reasonably constructed column diagram model has good discriminatory power and accuracy, which can be used for risk stratification of patients.
- Acute ischemic stroke /
- Intravenous thrombolysis /
- Reocclusion of blood vessels /
- Influencing factor

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图 1 AIS患者静脉溶栓治疗后血管再闭塞的列线图

Figure 1. The nomogram of vessels reocclusion after intravenous thrombolysis in AIS patients

下载: 全尺寸图片幻灯片

图 2 列线图预测AIS患者静脉溶栓后血管再闭塞的ROC曲线

Figure 2. The ROC curve of nomogram for predicting reocclusion of blood vessels after intravenous thrombolysis in AIS patients

下载: 全尺寸图片幻灯片

图 3 列线图预测模型的校准曲线

Figure 3. Calibration curve of nomogram for predicting reocclusion of blood vessels after intravenous thrombolysis in AIS patients

下载: 全尺寸图片幻灯片

图 4 列线图预测模型的临床决策曲线

Figure 4. The clinical decision curve of the model predicted by the nomogram

下载: 全尺寸图片幻灯片

表 1 AIS患者静脉溶栓治疗后血管再闭塞的单因素分析

Table 1. Univariate analysis of vascular re-occlusion after intravenous thrombolysis in AIS patients

项目	无闭塞组(n=264)	再闭塞组(n=52)	统计量	P值
年龄(x±s，岁)	58.69±8.94	59.21±9.63	0.378^a	0.705
性别(男/女，例)	154/110	32/20	0.184^b	0.668
吸烟史[例(%)]	128(48.48)	29(55.77)	0.922^b	0.337
冠心病史[例(%)]	50(18.94)	15(28.85)	2.610^b	0.106
房颤史[例(%)]	62(23.48)	24(46.15)	11.270^b	0.001
OSAHS史[例(%)]	43(16.29)	12(23.08)	1.393^b	0.238
高血压[例(%)]	96(36.36)	25(48.08)	2.523^b	0.112
糖尿病[例(%)]	70(26.52)	20(38.46)	3.044^b	0.081
高脂血症[例(%)]	63(23.86)	17(32.69)	1.791^b	0.181
BMI(x±s)	22.18±2.64	22.36±2.73	0.447^a	0.655
是否应用替罗非班[例(%)]			6.144^b	0.013
是	86(32.58)	8(15.38)
否	178(67.42)	44(84.62)
入院收缩压(x±s, mmHg)	146.52±10.24	147.63±9.28	0.725^a	0.469
入院舒张压(x±s, mmHg)	86.97±8.64	87.53±7.58	0.435^a	0.664
入院血糖(x±s, mmol/L)	7.43±1.26	7.64±1.38	1.081^a	0.280
基线NIHSS评分(x±s, 分)	11.36±4.52	14.48±3.27	4.737^a	<0.001
发病到治疗时间(x±s, min)	189.63±30.79	208.47±25.64	4.137^a	<0.001
梗死部位[例(%)]			0.317^b	0.853
前循环	205(77.65)	39(75.00)
后循环	48(18.18)	10(19.23)
前循环+后循环	11(4.17)	3(5.77)
TOAST分型[例(%)]			0.729^b	0.948
小动脉闭塞型	92(34.85)	16(30.77)
大动脉粥样硬化型	114(43.18)	24(46.15)
心源性栓塞型	52(19.70)	10(19.23)
其他	6(2.27)	2(3.85)
注：^a为t值，^b为χ²值。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 变量赋值情况

Table 2. Variable assignment

变量	变量类型	赋值方法
血管再闭塞	因变量	否=0，是=1
房颤史	自变量	无=0，有=1
是否应用替罗非班	自变量	否=0，是=1
基线NIHSS评分	自变量	连续型变量，以实际值赋值
发病到治疗时间	自变量	连续型变量，以实际值赋值

下载: 导出CSV

表 3 AIS患者静脉溶栓治疗后血管再闭塞的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of vascular reocclusion after intravenous thrombolysis in AIS patients

变量	B	SE	Waldχ²	P值	OR(95% CI)
房颤史	0.984	0.393	6.269	0.012	2.675(1.238~5.779)
是否应用替罗非班	-0.532	0.208	6.542	0.011	0.587(0.391~0.883)
基线NIHSS评分	0.638	0.206	9.592	0.002	1.893(1.264~2.834)
发病到治疗时间	0.224	0.107	4.883	0.027	1.251(1.014~1.543)

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