急性前循环大血管闭塞性卒中血管再通后恶性脑水肿发生的预测模型  

Establishment of the prediction models of malignant brain edema after vascular recanalization in anterior circulation acute large vascular occlusion stroke

作　　者：承军[1] 李虎[2] 黄晓成[1] 王海华[1] Cheng Jun;Li Hu;Huang Xiaocheng;Wang Haihua(Department of Neurosurgery,Jiangyin Hospital of Traditional Chinese Medicine,Jiangyin 214400,China;Department of Intervention,Jiangyin Hospital of Traditional Chinese Medicine,Jiangyin 214400,China)

机构地区：[1]江阴市中医院神经外科,214400 [2]江阴市中医院介入科,214400

出　　处：《国际外科学杂志》2022年第1期15-23,F0003,共10页International Journal of Surgery

摘　　要：目的基于Logistic回归模型和XGBoost算法模型构建前循环急性大血管闭塞性卒中(ALVOS)血管再通后恶性脑水肿(MBE)发生的预测模型,并比较预测性能。方法回顾性选取2014年3月—2020年6月于江阴市中医院行早期血管内治疗(EVT)后闭塞血管成功再通的前循环ALVOS患者382例,采用随机数字表法按7∶3的比例将患者分为训练组(n=267)和测试组(n=115),根据患者闭塞血管成功再通后是否发生MBE,将训练组分为MBE组(n=41)和非MBE组(n=226)。分别比较训练组与测试组及训练组中MBE组与非MBE组的基线资料、治疗情况、颅脑计算机断层扫描灌注成像检查结果,包括年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、脑侧支循环分级、脑血容量等指标。采用Logistic回归模型和XGBoost算法模型筛选闭塞血管成功再通的前循环ALVOS患者发生MBE的预测因素,比较两个模型的区分度和校准度。符合正态分布的计量资料以均数±标准差(±s)表示,两组间比较采用独立样本t检验,非正态分布的计量资料以M(Q_(1),Q_(3))表示,采用独立样本Mann-Whitney U检验,计数资料组间比较采用χ^(2)检验。结果训练组和测试组患者的基线资料、治疗情况、颅脑计算机断层扫描灌注成像检查结果差异无统计学意义(P>0.05);MBE组患者的年龄、入院收缩压、入院NIHSS评分、高血压比例、脑侧支循环0~2级比例、取栓次数>3次比例、发病至血管再通时间、脑血容量分别为(68.95±8.04)岁、(146.71±22.73)mmHg、17(13,21)分、87.80%、82.93%、68.29%、(365.64±87.83)min、(32.56±5.73)mL/100 g,明显高于非MBE组[(60.27±7.13)岁、(137.92±19.58)mmHg、14(10,18)分、73.01%、60.62%、2.65%、(307.59±74.05)min、(27.49±5.46)mL/100 g](P<0.05);Logistic回归模型结果表明,年龄、入院NIHSS、脑侧支循环分级、取栓次数、发病至血管再通时间是前循环ALVOS患者行EVT后闭塞血管成功再通后发生MBE的预测�Objective Based on Logistic regression and XGBoost algorithm,the prediction model of malignant brain edema(MBE)after vascular recanalization of anterior circulation acute great vessel occlusive stroke(ALVOS)was constructed,and the prediction performance was compared.Methods A retrospective selection of 382 patients with anterior circulation ALVOS who underwent early endovascular treatment(EVT)in our hospital from March 2014 to June 2020 and successfully recanalized the occluded blood vessel was selected.The patients were divided into the training group(n=267)and the test group(n=115)according to the ratio of 7∶3 by the random number table method.According to whether the patients had MBE after successful recanalization of the occluded blood vessels,the training group was divided into the MBE group(n=41)and non-MBE group(n=226).The baseline data,treatment and brain computed tomography perfusion(CTP)results of MBE group and non-MBE group in training group and test group were compared respectively,including age,admission score of National Institutes of Health Stroke Scale(NIHSS),grade of cerebral collateral circulation,cerebral blood volume,and so on.Logistic regression model and XGBoost algorithm model were used to screen the predictors of MBE in ALVOS patients with occluded vessels successfully recanalized,and the discrimination and calibration of the two models were compared.The measurement data conforming to the normal distribution were expressed as mean±standard deviation(±s),and the independent sample t test was used for comparison between the two groups.Non-normally distributed measurement data were represented by M(Q1,Q3),using independent sample Mann-Whitney U test.The chi-square test was used to compare the count data between groups.Results There was no significant difference in baseline data,treatment status,and cranial computed tomography perfusion(CTP)imaging results of the training group and the test group(P>0.05).The age,admission systolic blood pressure,admission NIHSS score,proportion of hyperten

关 键 词：卒中 脑水肿 血管 Logistic模型 XGBoost算法模型 血管再通 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R742[医药卫生—临床医学]