急性缺血性卒中患者卒中后谵妄预测模型的构建与验证  

Construction and validation of predictive model for post-stroke delirium in patients with acute ischemic stroke

作　　者：范乐乐 马靓 徐艳 于杰 苗晓 Fan Lele;Ma Liang;Xu Yan;Yu Jie;Miao Xiao(Emergency Room,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Nursing Department,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China)

机构地区：[1]徐州医科大学附属连云港医院急诊抢救室,连云港222002 [2]徐州医科大学附属连云港医院护理部,连云港222002 [3]徐州医科大学附属连云港医院神经外科,连云港222002

出　　处：《国际脑血管病杂志》2022年第9期664-670,共7页International Journal of Cerebrovascular Diseases

基　　金：连云港市科技计划项目(SF2146)。

摘　　要：目的构建急性缺血性卒中(acute ischemic stroke,AIS)患者发生卒中后谵妄(post-stroke delirium,PSD)的预测模型,并对其预测价值进行验证。方法前瞻性纳入徐州医科大学附属连云港医院神经内科在2022年2月至5月期间收治的AIS患者,按入组先后顺序分为建模组和验证组。根据患者是否发生谵妄,将建模组患者分为谵妄组和非谵妄组。通过多变量logistic回归分析确定PSD的独立危险因素并据此构建PSD预测模型。应用受试者工作特征曲线验证模型预测价值。结果建模组纳入350例AIS患者,其中71例(20.28%)发生PSD;验证组纳入150例AIS患者,其中36例(24.00%)发生PSD。多变量logistic回归分析表明,年龄[优势比(odds ratio,OR)1.036,95%置信区间(confidence interval,CI)1.000~1.074;P=0.050]、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR 1.607,95%CI 1.438~1.797;P<0.001)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)(OR 1.135,95%CI 1.016~1.267;P=0.025)以及心房颤动(OR 5.528,95%CI 1.315~23.245;P=0.020)为PSD的独立危险因素。预测模型为:Z=0.036×年龄+0.475×NIHSS评分+0.127×NLR+1.710×心房颤动赋值-10.160。模型的曲线下面积为0.935,敏感性和特异性分别为97.2%和82.5%。结论该模型可有效预测AIS患者的PSD风险,具有较高的敏感性和特异性,可为AIS患者的PSD筛查提供依据。Objective To construct a predictive model of post-stroke delirium(PSD)in patients with acute ischemic stroke(AIS),and to verify its predictive value.Methods Patients with AIS admitted to the Department of Neurology,Lianyungang Hospital Affiliated to Xuzhou Medical University from February to May 2022 were enrolled prospectively.They were divided into modeling group and validation group according to the order of enrollment.Depending on whether the patients had delirium or not,the patients in the modeling group were divided into delirium group and non-delirium group.The independent risk factors for PSD were determined by multivariable logistic regression analysis,and the prediction model of PSD was constructed accordingly.The predictive value of the model was verified by the receiver operating characteristic curve.Results Three hundred and fifty patients with AIS were included in the modeling group,of which 71(20.28%)had PSD.The validation group included 150 patients with AIS,and 36 of them(24.00%)had PSD.Multivariate logistic regression analysis showed that age(odds ratio[OR]1.036,95%confidence interval[CI]1.000-1.074;P=0.050),National Institutes of Health Stroke Scale(NIHSS)score(OR 1.607,95%CI 1.438-1.797;P<0.001),neutrophil/lymphocyte ratio(NLR)(OR 1.135,95%CI 1.016-1.267;P=0.025),and atrial fibrillation(OR 5.528,95%CI 1.315-23.245;P=0.020)were the independent risk factors for PSD.The predictive model was Z=0.036×age+0.475×NIHSS score+0.127×NLR+1.710×assignment of atrial fibrillation-10.160.The area under the curve of the model was 0.935,and the sensitivity and specificity were 97.2%and 82.5%respectively.Conclusion This model can effectively predict the PSD risk of patients with AIS,with higher sensitivity and specificity,and can provide a basis for PSD screening of patients with AIS.

关 键 词：卒中 脑缺血 谵妄 危险因素 模型 理论 试验预期值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]