基于临床数据构建烟雾病与非烟雾病缺血性卒中的鉴别诊断模型  

Construction of a differential diagnosis model of ischemic stroke between moyamoya disease and non-moyamoya disease based on clinical data

作　　者：滕勇士 代淑华 刘慧勤 秦灵芝 薛红飞 徐佳佳 李玮 TENG Yongshi;DAI Shuhua;LIU Huiqin;QIN Lingzhi;XUE Hongfei;XU Jiajia;LI Wei(Internal Department of Neurology,People′s Hospital of Zhengzhou University,Henan Provincial People′s Hospital,Zhengzhou,Henan,450003;Xinxiang Medical University,Xinxiang,Henan,453003;Henan University,Zhengzhou,Henan,450046)

机构地区：[1]郑州大学人民医院/河南省人民医院神经内科,河南郑州450003 [2]新乡医学院,河南新乡453003 [3]河南大学,河南郑州450046

出　　处：《实用临床医药杂志》2023年第8期1-6,12,共7页Journal of Clinical Medicine in Practice

基　　金：河南省医学科技攻关计划项目(SBGJ2018077)。

摘　　要：目的筛选临床上易于获得的变量构建烟雾病(MMD)与非MMD缺血性卒中的鉴别诊断模型。方法纳入确诊为MMD缺血性卒中患者150例和非MMD缺血性卒中患者150例,按照7∶3的比例分为训练组(210例)和验证组(90例)。利用Logistic回归分析、Lasso回归、支持向量机(SVM)构建诊断模型;通过列线图将最优模型可视化,并分别在训练组和验证组中检验列线图的鉴别能力。结果二分类Logistic回归模型在训练组和验证组中C统计量最大(0.87和0.88)。多因素Logistic回归分析差异有统计学意义(P<0.05)的变量为收缩压、总胆固醇(TC)、白蛋白(ALB)、游离三碘甲腺原氨酸(FT_(3))、同型半胱氨酸(HCY)、年龄,将这6个变量纳入列线图。列线图在训练组和验证组的Hosmer-Lemeshow检验P值分别为0.28、0.19,校正曲线校正度良好。列线图评分<168分为MMD缺血性卒中低风险,列线图评分≥168分为MMD缺血性卒中高风险。结论本研究构建的列线图可鉴别MMD和非MMD缺血性卒中,经过验证该模型在训练组和验证组中均有良好的鉴别能力。Objective To establish a differential diagnosis model between moyamoya disease(MMD)and non-MMD ischemic stroke by screening clinically accessible variables.Methods A total of 150 patients diagnosed with MMD ischemic stroke and 150 patients diagnosed with non-MMD ischemic stroke were included and divided into training group(210 cases)and validation group(90 cases)according to a ratio of 7 to 3.Logistic regression analysis,Lasso regression and support vector machine(SVM)were used to construct the diagnosis model;the optimal model was visualized with nomogram,and discriminant ability of the nomogram was tested in the training group and the validation group respectively.Results Binary Logistic regression showed the largest C statistics in the training group and the verification group(0.87 and 0.88).Multivariate logistic regression analysis showed statistically significant differences(P<0.05)in systolic blood pressure,total cholesterol(TC),albumin(ALB),free triiodothyranine(FT_(3)),homocysteine(HCY)and age,and these six variables were included in the nomogram.Hosmer-Lemeshow test P values for the training group and the verification group were 0.28 and 0.19,respectively,and the calibration curve was well calibrated.The nomogram score<168 was classified as a low risk of ischemic stroke in MMD,and the nomogram score≥168 was classified as a high risk of ischemic stroke in MMD.Conclusion The nomograms established in the study can be used to distinguish MMD from non-MMD ischemic stroke,and it has been verified that the model has good discriminative ability in both training group and verification group.

关 键 词：烟雾病 缺血性脑卒中 鉴别诊断模型 列线图 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R741.04[医药卫生—临床医学]