基于中医复合体质的缺血性中风病复发早期预警模型的构建及验证  

Development and Validation of an Early Warning Model for Ischemic Stroke Recurrence Based on Complex TCM Constitutions

作　　者：高阳 谢雁鸣[2] 张景肖[3] 王蕾[3] 蔡业峰[4] 沈晓明[5] 赵德喜[6] 谢颖桢[7] 赵性泉[8] 孟繁兴[1] 于海青[9] 姜俊杰[2] GAO Yang;XIE Yan-ming;ZHANG Jing-xiao;WANG Lei;CAI Ye-feng;SHEN Xiao-ming;ZHAO De-xi;XIE Ying-zhen;ZHAO Xing-quan;MENG Fan-xing;YU Hai-qing;JIANG Jun-jie(Dongfang Hospital,Beijing University of Chinese Medicine,Bejing 100078;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700;Renmin University of China,Beijing 100872;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou Guangdong 510120;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou Henan 450000;The Affiliated Hospital of Changchun University of Chinese Medicine,Changchun Jjilin 130021;Dongzhimen Hospital,Beijing University of Chinese Medicine,Bejing 100700;Bejjing Tiantan Hospital,Capital Medical University,Bejjing 100070,China;Taiyuan Hospital of Traditional Chinese Medicine,Taiyuan Shanxi 030009)

机构地区：[1]北京中医药大学东方医院,北京100078 [2]中国中医科学院中医临床基础医学研究所,北京100700 [3]中国人民大学,北京100872 [4]广东省中医院,广东广州510120 [5]河南中医药大学第一附属医院,河南郑州450000 [6]长春中医药大学附属医院,吉林长春130021 [7]北京中医药大学东直门医院,北京100700 [8]首都医科大学附属北京天坛医院,北京100070 [9]太原市中医医院,山西太原030009

出　　处：《世界中西医结合杂志》2022年第10期1955-1961,共7页World Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药管理局2015年度中医药行业科研专项(201507003-8);科技部国家重点研发计划(2018YFC1704705)。

摘　　要：目的开发和验证中医复合体质的缺血性中风病复发早期预警模型和风险评估工具。方法采用多中心、前瞻性的注册登记研究设计,选取2016年11月10日—2019年2月17日期间7家临床分中心(北京中医药大学东直门医院、首都医科大学附属北京天坛医院、广东省中医院、长春中医药大学附属医院、河南中医药大学附属第一医院、北京中医药大学东方医院、太原市中医医院)1741例首发缺血性中风病的住院患者。采用距离相关系数、互信息熵和广义线性混合模型进行了单变量分析,变量多因素分析采用多因素的Cox回归模型并结合中风领域的专家意见进行建模变量的确定。使用Cox比例风险回归模型进行不同时间的中风复发预警模型的构建和验证。使用ROC曲线下面积(AUC值)评估模型的预警能力。结果随访时间1~3年,中位随访时间为1.42年(95%CI:1.37-1.47)。175例发生了复发事件,累积复发发生率10.05%(95%CI:8.64-11.47)。模型训练集的AUC值为(0.62±0.03),验证集AUC值为(0.70±0.03)。结论中医复合体质模型可能较早的对中风复发进行预警,为缺血性中风的二级预防评估提供一定的参考。Objective To develop and validate an early warning model for ischemic stroke recurrence based on complex TCM constitutions.Methods A prospective,multi-center and registered study was conducted.A total of 1741 patients with first-ever ischemic stroke admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing Tiantan Hospital of Capital Medical University,Guangdong Provincial Hospital of Chinese Medicine,The Affiliated Hospital of Changchun University of Chinese Medicine,The First Affiliated Hospital of Henan University of Chinese Medicine,Dongfang Hospital of Beijing University of Chinese Medicine,and Taiyuan Hospital of Traditional Chinese Medicine from November 10,2016 to February 17,2019 were enrolled in this study.The univariate analysis was carried out with distance correlation coefficient,mutual information entropy,and generalized linear mixed model.The multivariate analysis adoptedmulti-factor Cox regression model and the variables determined based on the opinions of experts in the field of stroke.The Cox proportional hazard regression model was used to establish the early warning model of stroke recurrence in different time periods and then the warning model was validated.The area under the ROC curve(AUC value)was employed to evaluate the early warning performance of the established model.Results The follow-up time ranged from 1 to 3 years,with the median of 1.42 years(95%CI:1.37-1.47).Ischemic stroke reoccurred in 175 patients,and the cumulative recurrence rate was 10.05%(95%CI:8.64%-11.47%).The AUC values of the training set and validation set were 0.62±0.03 and 0.70±0.03,respectively.Conclusions The model established based on complex TCM constitutions can provide early warning of stroke recurrence,which provides a reference for the evaluation of secondary prevention of ischemic stroke.

关 键 词：缺血性中风病 复发 预警模型 风险评估工具 中医体质 

分 类 号：R255.2[医药卫生—中医内科学]