基于多元逻辑回归锁骨下动脉及椎动脉狭窄性病变与后循环缺血相关性的临床研究  

Clinical Study on the Correlation Between Subclavian Artery and Vertebral Artery Stenosis and Posterior Circulation Ischemia Based on Multiple Logistic Regression

作　　者：张灵艳 惠品晶[1] 颜燕红[1] 陶青 胡春洪[3] ZHANG Ling-yan;HUI Pin-jing;YAN Yan-hong;TAO Qing;HU Chun-hong(Department of Carotid and Cerebralvascular Ultrasonography,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Ultrasound,Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu,215125,China;Department of Radiology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院卒中中心-颈脑血管超声科,江苏苏州215006 [2]苏州大学附属独墅湖医院超声科,江苏苏州215125 [3]苏州大学附属第一医院放射科,江苏苏州215006

出　　处：《中国血液流变学杂志》2023年第1期129-135,共7页Chinese Journal of Hemorheology

基　　金：苏州市民生科技项目(SS202061);苏州大学技术开发合作项目(H211064)。

摘　　要：目的探讨基于颈脑血管超声(CDU)患者的锁骨下动脉及椎动脉参数的多元逻辑回归模型预测磁共振(MRI)证实的后循环梗死的可行性。方法回顾性连续纳人2022年1月-2022年12月于苏州大学附属第一医院卒中中心就诊的患者184例,男性126例,女性58例,年龄40~89岁,患者1周内分别进行MRI和CDU检查,并且CDU检查诊断为锁骨下动脉窃血综合征(SSS)。观察每一位患者的后循环供血区的MRI图像,将其中MRI证实为后循环梗死的病人作为梗死组,共纳人65例患者。将其中MRI证实后循环无梗死的病人作为对照组,共纳入119例患者。使用CDU检查评估每一位患者的锁骨下动脉狭窄率、SSS类型、易损斑块情况、收缩期峰值流速(PSV)、舒张期末流速(EDV)等参数。采用独立样本t检验以及×2检验比较两组患者年龄、性别、生化指标、锁骨下动脉狭窄率、SSS类型、易损斑块情况、PSV、EDV等参数,筛选出两组之间P<0.10的参数。使用受试者特征曲线(ROC)分别评估每个参数预测后循环缺血的诊断效能。随后使用多元逻辑回归将P<0.10的参数建立多元逻辑回归模型,评估模型对于后循环梗死的诊断效能。结果对梗死组与对照组进行统计分析,性别、年龄差异具有统计学意义(P<0.05)。对所有参数进行统计分析后,得到P<0.10的参数总共10个,包括6个临床参数以及4个CDU参数。对纳入的每一个参数分别进行ROC分析,得到单因素诊断效能最高的参数为右侧椎动脉狭窄率。最后使用这10个参数建立了临床综合模型,曲线下面积则可以达到0.767,灵敏度和特异度分别为0.723和0.748。结论基于CDU得到的多参数联合模型对后循环梗死有较好的预测作用,可以为临床相关的病人提供新的诊疗思路。Objective To investigate the feasibility of predicting posterior circulation infarction confirmed by magnetic resonance imaging(MRI)by multiple logistic regression model based on subclavian artery and vertebral artery parameters in patients with carotid Doppler ultrasound(CDU).Methods A total of 184 patients(126 males and 58 females,aged 40-89 years)admitted to the Stroke Center of the First Affiliated Hospital of Soochow University from January 2022 to December 2022 were retrospectively included.The patients underwent MRI and CDU examination within one week,respectively,and were diagnosed as subclavian artery steal syndrome(SSS)by CDU examination.MRI of the posterior circulation blood supply area of each patient were observed,and patients with posterior circulation infarction confirmed by MRI were included as the infarction group,a total of 65 patients were included.A total of 119 patients were included in the control group whose MRI confrmed no infarction in the posterior circulation.Subclavian artery stenosis rate,type of SSS,vulnerable plaque,peak systolic flow rate(PSV),end diastolic flow rate(EDV)were evaluated using CDU.Use independent sample t-test and x test compare two groups of patients'age,gender,and biochemical indexes,the types of subclavian artery stenosis rate,SSS,vulnerable plaques,PSV,EDV,and other parameters.Parameters with P<o.10 between the two groups were screened.The diagnostic eficacy of each parameter in predicting posterior circulation ischemia was evaluated using receiver operator characteristic curve(ROC).Subsequently,multiple logistic regression was used to establish a multiple logistic regression model with parameters P<o.10 to evaluate the diagnostic effectiveness of the model for posterior circulation infarction.Results Statistical analysis of infarct group and control group showed that gender and age had statistical differences(P<0.05).After statistical analysis of all parameters,a total of 10 parameters with P<0.10 were obtained,including 6 clinical parameters and 4 CDU parameter

关 键 词：锁骨下动脉窃血 血管超声 磁共振成像 后循环缺血 多元逻辑回归 

分 类 号：R445.1[医药卫生—影像医学与核医学]