急性脑梗死静脉溶栓联合早期应用替罗非班注射液治疗预后不良的风险预测列线图模型构建研究  

Construction of nomogram model for risk prediction of poor prognosis in acute cerebral infarction that was treated with intravenous thrombolysis combined with early tirofiban injection

作　　者：高延伦 王艳晖 薛文俊[1] Gao Yanlun;Wang Yanhui;Xue Wenjun(Second ward,department of neurology,the first people's hospital of Pingdingshan,Pingdingshan,Henan,467000,China;Second ward,department of gastroenterology,the first people's hospital of Pingdingshan,Pingdingshan,Henan,467000,China)

机构地区：[1]平顶山市第一人民医院神经内科二病区,河南平顶山467000 [2]平顶山市第一人民医院消化内科二病区,河南平顶山467000

出　　处：《齐齐哈尔医学院学报》2023年第3期209-213,共5页Journal of Qiqihar Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191262)。

摘　　要：目的探讨急性脑梗死(ACI)静脉溶栓联合早期应用替罗非班注射液治疗预后不良的影响因素,并依此建立列线图预测模型。方法回顾性分析2018年1月—2022年1月本院收治的243例ACI患者的临床资料,根据预后情况将其分为预后良好组(172例)和预后不良组(71例)两组。采用多因素Logistic回归分析法分析ACI静脉溶栓联合早期应用替罗非班注射液治疗预后不良的影响因素并绘制列线图模型,列线图的预测效能和预测能力分别用受试者工作特征(ROC)曲线评估和Bootstrap法检验。结果年龄>65岁、责任大动脉病变、OCSP分型为完全前循环梗死、NHISS评分高、发病至溶栓时间长、FBG水平升高均为ACI静脉溶栓联合早期应用替罗非班注射液治疗预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,根据多因素分析构建的列线图模型预测ACI静脉溶栓联合早期应用替罗非班注射液治疗预后不良的曲线下面积、灵敏度和特异度分别为0.848(95%CI:0.796-0.890)、77.46%、82.56%;经Bootstrap法进行内部验证,其一致性指数(C-index)为0.821,校正曲线与标准曲线贴合度较好。结论基于风险因素的列线图模型具有良好的校准度,有助于在进行静脉溶栓联合早期应用替罗非班注射液治疗的ACI患者中筛选出预后不良者。Objective To investigate the influencing factors of poor prognosis in the treatment of acute cerebral infarction(ACI)with intravenous thrombolysis combined with early tirofiban injection,and to establish a nomogram prediction model based on this.Methods The clinical data of 243 patients suffered from ACI,those were admitted to our hospital from January 2019 to January 2022,were retrospectively analyzed.They were divided into a good prognosis group(172 cases)and a poor prognosis group(71 cases)according to the prognosis.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis of intravenous thrombolysis combined with early application of tirofiban injection in treating ACI and to draw a nomogram model.The predictive efficacy and predictive ability of the nomogram were evaluated by receiver operating characteristic(ROC)curve and Bootstrap method.Results The age over 65 years old,responsible aorta disease,complete anterior circulation infarction according to OCSP classification,high NHISS score,long duration from onset to thrombolysis,and increased FBG level were the risk factors of poor prognosis in the treatment of ACI with intravenous thrombolysis combined with early tirofiban injection(P<0.05).The results of ROC curve analysis showed that the area under the curve,sensitivity and specificity of the nomogram model based on multivariate analysis to predict the poor prognosis of intravenous thrombolysis combined with early application of tirofiban injection in treating ACI were 0.848(95%CI:0.796-0.890),77.46%and 82.56%,respectively.The Bootstrap method was used for internal verification,and the consistency index(C-index)was 0.821.The calibration curve and the standard curve fit well.Conclusions The nomogram model based on risk factors has good calibration,which is helpful to screen out the cases with poor prognosis among patients suffered from ACI those were treated with intravenous thrombolysis combined with early application of tirofiban injection.

关 键 词：急性脑梗死 静脉溶栓 替罗非班 预后不良 列线图 预测模型v 

分 类 号：R743.3[医药卫生—神经病学与精神病学]