急性缺血性脑卒中患者并发深静脉血栓风险预测列线图模型构建与评价  

Construction and evaluation of nomogram model for risk prediction of deep vein thrombosis in patients with acute ischemic stroke

作　　者：杭代 蔡志敏[1] 刘才荣 Hang Dai;Cai Zhimin;Liu Cairong(Department of General Medicine,Gulou Hospital Affiliated to Nanjing University School of Medicine,Jiangsu 210000,China)

机构地区：[1]南京大学医学院附属鼓楼医院全科医学科,江苏210000

出　　处：《脑与神经疾病杂志》2024年第8期497-503,共7页Journal of Brain and Nervous Diseases

基　　金：江苏省科技计划项目(2021-Z04-075)。

摘　　要：目的探讨急性缺血性脑卒中(AIS)患者并发深静脉血栓(DVT)的危险因素,并构建并发DVT的预测模型。方法纳入2018年1月-2023年1月于南京大学医学院附属鼓楼医院全科医学科接受治疗的455例AIS患者的临床资料,将患者是否并发DVT分为DVT组和非DVT组,收集患者的临床资料,采用Logistic回归分析明确AIS患者并发DVT的独立影响因素,将获得的独立影响因素纳入构建列线图预测模型,采用R软件中C指数、受试者工作曲线(ROC)及校准曲线评价AIS患者并发DVT风险的列线图模型效能。结果本院全科医学科接受治疗的455例AIS患者中,并发DVT的患者45例,占比9.89%。两组临床资料比较中,性别、体质量指数(BMI)、病程、高血压、吸烟史、饮酒史、收缩压、舒张压、空腹血糖(FBG)、总胆固醇(TC)、红细胞计数(RBC)、白细胞计数(WBC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)以及低密度脂蛋白胆固醇(LDL-C)对比差异无统计学意义(P>0.05);DVT组的年龄、高血糖、美国国立卫生院卒中量表(NIHSS)评分、卧床时间、血小板计数以及纤维蛋白原(FIB)均>非DVT组,DVT组的D-二聚体和凝血酶时间(TT)均<非DVT组,差异有统计学意义(^(均)P<0.05)。经Logistics回归分析显示年龄大、高血糖、NIHSS评分高、卧床时间长、血小板计数多、FIB水平高、D-二聚体水平高以及TT短均是AIS患者并发DVT的独立影响因素(^(均)P<0.05)。绘制ROC曲线,结果显示,年龄、高血糖、NIHSS评分、卧床时间、血小板计数、FIB、D-二聚体和TT的曲线下面积(AUC)值均>0.700,说明上述指标对于AIS患者并发DVT具有较好的预测价值。基于以上影响因素建立列线图风险模型,验证结果显示,校准曲线的C-index值为0.850,说明该列线图模型具备较好的区分度,ROC曲线建模组和验证组的AUC分别为0.850和0.901,说明该列线图模型具有良好的预测能效和判别能力。结论基于AIS患者并发DVTObjective To investigate the risk factors of deep vein thrombosis(DVT)in acute ischemic stroke(AIS)patients,and to establish a prediction model of DVT.Methods Clinical data of 455 AIS patients treated in the General Medicine Department of Gulou Hospital Affiliated to Nanjing University Medical College from January2018 to January 2023 were included.The patients were divided into DVT group and non DVT group to determine whether they had concurrent DVT.Clinical data of the patients were collected,and logistic regression analysis was used to identify the independent influencing factors of AIS patients with concurrent DVT.The obtained independent influencing factors were included in the construction of a column chart prediction model,and the C index in R software was used The efficacy of the column chart model for evaluating the risk of DVT in AIS patients using the receiver operating curve(ROC)and calibration curve.Results Among the 455 AIS patients treated in the general practice department of our hospital,45 were complicated with DVT,accounting for 9.89%.In the comparison of clinical data between the two groups,there was no difference in gender,body mass index(BMI),course of disease,hypertension,smoking history,drinking history,systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),total cholesterol(TC),red blood cell count(RBC),white blood cell count(WBC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)(P>0.05);The age,hyperglycemia,National Institutes of Health Stroke Scale(NIHSS)score,bed rest time,platelet count,and fibrinogen(FIB)of the DVT group were higher than those of the non DVT group,while the D-dimer and thrombin time(TT)of the DVT group were lower than those of the non DVT group,with statistically significant differences(^(all)P<0.05).Logistic regression analysis showed that age,hyperglycemia,high NIHSS score,long bed rest time,high platelet count,high FIB level,high D-dimer level,and short TT were independent influencing

关 键 词：急性缺血性脑卒中 深静脉血栓 危险因素 列线图预测模型 

分 类 号：R743.32[医药卫生—神经病学与精神病学]