非急性期颈内动脉闭塞血管内再通治疗后成功再通的决策树预测模型  

A decision tree model to predict successful endovascular recanalization of non-acute internal carotid artery occlusion

作　　者：霍淑娴 侯超 施璇 殷勤 黄显军[2] 孙文 肖国栋[4] 杨勇[5] 陈红兵[6] 李敏[7] 杜明洋[8] 韩云飞 樊小兵 刘新峰 叶瑞东 Huo Shuxian;Hou Chao;Shi Xuan;Yin Qin;Huang Xianjun;Sun Wen;Xiao Guodong;Yang Yong;Chen Hongbing;Li Min;Du Mingyang;Han Yunfei;Fan Xiaobing;Liu Xinfeng;Ye Ruidong(Department of Neurology,the Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Department of Neurology,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China;Cerebrovascular Disease Center/Department of Neurology,the First Affiliated Hospital of USTC(Anhui Provincial Hospital),Hefei 230001,China;Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Neurology,Guangzhou First People's Hospital,Guangzhou 510180,China;Department of Neurology,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of Neurology,Jiangsu Province Hospital of Chinese Medicine,Nanjing University of Chinese Medicine,Nanjing 210029,China;Cerebrovascular Disease Treatment Center,Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京大学医学院附属金陵医院神经内科,南京210002 [2]皖南医学院附属弋矶山医院神经内科,芜湖241001 [3]中国科技大学附属第一医院(安徽省立医院)脑血管病中心暨神经内科,合肥230001 [4]苏州大学附属第二医院神经内科,苏州215004 [5]广州市第一人民医院神经内科,广州510180 [6]中山大学附属第一医院神经内科,广州510080 [7]南京中医药大学附属江苏省中医院神经内科,南京210029 [8]南京医科大学附属脑科医院脑血管病救治中心,南京210029

出　　处：《国际脑血管病杂志》2023年第7期481-489,共9页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81870946,U22A20341);江苏省重点研发计划(BE2020697)。

摘　　要：目的探讨非急性期有症状颈内动脉闭塞(symptomatic internal carotid artery occlusion,SICAO)血管内再通治疗后成功再通的预测因素,利用分类和回归树(classification and regression tree,CART)算法建立决策树模型并评价模型预测效能。方法回顾性纳入在中国8家综合卒中中心接受血管内再通治疗的非急性期SICAO患者,随机分配至训练集和验证集。在训练集通过最小绝对收缩与选择算子(least absolute shrinkage and selection operator,LASSO)算法筛选重要变量,基于CART算法构建决策树预测模型。在验证集中使用受试者工作特征(receiver operating characteristic,ROC)曲线、Hosmer-Lemeshow拟合优度检验以及混淆矩阵进行模型评价。结果最终纳入非急性期SICAO患者511例,按7∶3比例随机划分为训练集(357例)和验证集(154例),血管内再通治疗后成功再通率分别为58.8%和58.4%,差异无统计学意义(χ2=0.007,P=0.936)。采用LASSO回归筛选出的6个系数不为零变量构建CART决策树模型,最终决策树纳入5个变量,共5层,包含9条分类规则。闭塞节段数较少、近端残腔为锥形、ASITN/SIR侧支分级1~2级、缺血性事件为缺血性卒中以及最近事件至血管内再通治疗时间为1~30 d是成功再通的预测指标。ROC分析显示,决策树模型训练集曲线下面积为0.810(95%置信区间0.764~0.857),模型预测成功再通的最佳截断值为0.71;验证集曲线下面积为0.763(95%置信区间0.687~0.839),准确度为70.1%,精密度为81.4%,敏感性为63.3%,特异性79.7%。两组中Hosmer-Lemeshow检验均P>0.05。结论基于缺血性事件类型、最近事件至血管内再通治疗时间、近端残腔形态、闭塞节段数和ASITN/SIR侧支分级构建的决策树模型能有效预测非急性期SICAO血管内再通治疗后成功再通。Objective To investigate predictive factors for successful endovascular recanalization in patients with non-acute symptomatic internal carotid artery occlusion(SICAO),to develop a decision tree model using the Classification and Regression Tree(CART)algorithm,and to evaluate the predictive performance of the model.Methods Patients with non-acute SICAO received endovascular therapy at 8 comprehensive stroke centers in China were included retrospectively.They were randomly assigned to a training set and a validation set.In the training set,the least absolute shrinkage and selection operator(LASSO)algorithm was used to screen important variables,and a decision tree prediction model was constructed based on CART algorithm.The model was evaluated using the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test and confusion matrix in the validation set.Results A total of 511 patients with non-acute SICAO were included.They were randomly divided into a training set(n=357)and a validation set(n=154)in a 7:3 ratio.The successful recanalization rates after endovascular therapy were 58.8%and 58.4%,respectively.There was no statistically significant difference(χ2=0.007,P=0.936).A CART decision tree model consisting of 5 variables,5 layers and 9 classification rules was constructed using the six non-zero-coefficient variables selected by LASSO regression.The predictive factors for successful recanalization included fewer occluded segments,proximal tapered stump,ASITN/SIR collateral grading of 1-2,ischemic stroke,and a recent event to endovascular therapy time of 1-30 d.ROC analysis showed that the area under curve of the decision tree model in the training set was 0.810(95%confidence interval 0.764-0.857),and the optimal cut-off value for predicting successful recanalization was 0.71.The area under curve in the validation set was 0.763(95%confidence interval 0.687-0.839).The accuracy was 70.1%,precision was 81.4%,sensitivity was 63.3%,and specificity was 79.7%.The Hosmer-Lemeshow test in both group

关 键 词：颈动脉疾病 颈内动脉 慢性病 血管内手术 治疗结果 试验预期值 决策树 

分 类 号：R743[医药卫生—神经病学与精神病学]