大血管闭塞性脑梗死患者预后的影响因素分析及其预测模型  

Analysis of influencing factors and prediction model of prognosis in patients with large vascular occlusive cerebral infarction

作　　者：冯晓丽 李威[1] 陈接桂 陈丽君 黄裕盛 Feng Xiaoli;Li Wei;Chen Jiegui;Chen Lijun;Huang Yusheng(Department of Neurology,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,Hainan,China)

机构地区：[1]海南医学院第一附属医院神经内科,海南海口570102

出　　处：《血管与腔内血管外科杂志》2024年第8期925-929,共5页Journal of Vascular and Endovascular Surgery

基　　金：海南省自然科学基金项目(823RC586);海南医学院第一附属医院青年培育基金项目(HYYFYPY202115)。

摘　　要：目的探讨大血管闭塞性脑梗死患者预后的影响因素并据此构建预测模型。方法收集2021年10月至2023年2月海南医学院第一附属医院收治的192例大血管闭塞性脑梗死患者的临床资料,根据患者随访90 d的改良Rankin量表(mRS)评分将其分为预后良好组(n=124,mRS评分0~2分)和预后不良组(n=68,mRS评分3~5分)。收集两组患者的一般资料、既往病史、疾病情况,采用Logistic回归模型分析大血管闭塞性脑梗死患者预后的影响因素,并据此构建预测模型,绘制受试者工作特征(ROC)曲线,分析预测模型的预测价值。结果高血压、大面积梗死、入院时美国国立卫生研究院卒中量表(NIHSS)评分﹥15分、肺部感染、心房颤动均是大血管闭塞性脑梗死患者预后不良的危险因素(P﹤0.05),根据上述危险因素构建的评分预测模型总分为0~7分,预测大血管闭塞性脑梗死患者预后不良的曲线下面积(AUC)为0.878(95%CI:0.820~0.960),以5分为最佳临界值,此时的灵敏度、特异度分别为0.904、0.802。结论高血压、大面积梗死、入院时NIHSS评分﹥15分、肺部感染、心房颤动均是大血管闭塞性脑梗死患者预后不良的危险因素,基于上述影响因素构建预测模型可客观、全面地评估患者预后不良的发生风险,有助于早期识别高危患者,简单方便,适合临床应用。Objective To explore the prognostic factors of patients with large vascular occlusive cerebral infarction and build the prediction model.Method Clinical data of patients with large vascular occlusive cerebral infarction admitted to the First Affiliated Hospital of Hainan Medical University from October 2021 to February 2023 were collected.According to the modified Rankin scale(mRS)score of 90 days of follow-up,the total of 192 patients with large vascular occlusive cerebral infarction were divided into good prognosis group(n=124,mRS score 0-2)and poor prognosis group(n=68,mRS score 3-5).General data,past medical history and disease status of patients in the two groups were collected,the factors influencing prognosis of patients with large vascular obliterated cerebral infarction were analyzed with Logistic regression model.The predictive model was built accordingly,receiver operator characteristic(ROC)curve was drawn,and the predictive value of the predictive model was analyzed.Result Hypertension,massive infarction,National Institute of Health stroke scale(NIHSS)score>15 score at admission,pulmonary infection and atrial fibrillation were all risk factors for poor prognosis in patients with large vascular occlusive cerebral infarction(P<0.05).The score prediction model constructed according to the above risk factors had a total score of 0-7.The area under the curve(AUC)was 0.878(95%CI:0.820-0.960)for predicting poor prognosis in patients with large vascular occlusive cerebral infarction,the optimal critical value was 5 score,with sensitivity and specificity of 0.904 and 0.802,respectively.Conclusion Hypertension,massive infarction,NIHSS score>15 score at admission,pulmonary infection and atrial fibrillation are all risk factors for poor prognosis in patients with large vascular obliterated cerebral infarction.The prediction model built based on the above influencing factors can objectively and comprehensively assess the risk of poor prognosis in patients,which is helpful for early identification of high-risk pati

关 键 词：大血管闭塞性脑梗死 前循环串联病变 预后 预测模型 高血压 肺部感染 房颤 

分 类 号：R543[医药卫生—心血管疾病]