基于颈动脉斑块内新生血管构建列线图评估症状性缺血性脑血管病发病风险  

A nomogram risk prediction model for symptomatic cerebrovascular ischaemia based on carotid intra-plaque neovascularisation

作　　者：马文渊 徐琦 马亚美 陈颖慧 Ma Wenyuan;Xu Qi;Ma Yamei;Chen Yinghui(Department of Ultrasonography,Wuhan Fourth Hospital,Wuhan430030,HubeiProvince,China)

机构地区：[1]武汉市第四医院超声科,430030 [2]襄阳市襄州区人民医院超声科

出　　处：《中华老年心脑血管病杂志》2024年第11期1310-1314,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 基于颈动脉斑块内新生血管建立缺血性脑血管病(ischemic cerebrovascular disease, ICVD)患者发生症状性脑缺血的风险列线图预测模型。方法 回顾性连续纳入2020年4月至2024年4月武汉市第四医院收治的ICVD患者320例,按照3:1比例分为训练集240例和验证集80例。训练集患者根据是否存在相关症状或体征又分为症状组147例和无症状组93例。采用多因素logistic回归分析ICVD患者发生症状性脑缺血的危险因素,构建列线图预测模型,并评估模型预测效能。结果 症状组斑块多发、溃疡性斑块、狭窄程度≥70%、斑块内新生血管比例明显高于无症状组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,斑块多发(OR=1.261,95%CI:1.088~1.539,P=0.003)、溃疡性斑块(OR=1.458,95%CI:1.132~1.661,P=0.001)、狭窄程度≥70%(OR=2.023,95%CI:1.458~2.561,P=0.001)、斑块内新生血管(OR=1.206,95%CI:1.057~1.489,P=0.002)是ICVD患者发生症状性脑缺血的独立危险因素。基于危险因素构建ICVD患者发生症状性脑缺血风险列线图预测模型,H-L偏差度检验显示出较好的拟合度(χ^(2)=9.362,P=0.295)。训练集和验证集内外部验证显示,校准曲线与原始曲线均保持一致,ROC曲线下面积分别为0.871和0.864。决策曲线分析显示,当预测风险阈值超过0.01时,该模型具有显著标准临床净收益。结论 超声造影在评估颈动脉粥样硬化斑块中斑块内新生血管的存在与否方面具有指导意义,基于斑块内新生血管构建的列线图对于症状性脑缺血的发生具有良好预测价值。Objective To construct a nomogram risk prediction model for symptomatic cerebrovascular ischaemia based on intra-plaque neovascularisation in carotid arteries in patients with ischemic cerebrovascular disease(ICVD).Methods A retrospective study was conducted on 320 ICVD patients who were consecutively admitted to Wuhan Fourth Hospital from April 2020 to April 2024.In a ratio of 3:1,240 cases were assigned into a training set and 80 cases into a validation set.The patients in the training set were further divided into 147 cases in the symptomatic subgroup and 93 cases in the asymptomatic subgroup according to the presence or absence of relevant symptoms or signs.Multifactorial logistic regression analysis was used to identify the risk factors for symptomatic ischemia in ICVD patients,and a nomogram risk prediction model was constructed and the prediction efficacy of the model was evaluated.Results The proportions of plaque multiplicity,ulcerated plaque,stenosis≥70%,and intra-plaque neovascularization were significantly higher in the symptomatic subgroup than the asymptomatic subgroup(P<0.05,P<0.01).Multifactorial logistic regression analysis showed that plaque multiplicity(OR=1.261,95%CI:1.088-1.539,P=0.003),ulcerated plaque(OR=1.458,95%CI:1.132-1.661,P=0.001),and stenosis≥70%(OR=2.023,95%CI:1.458-2.561,P=0.001),and intra-plaque neovascularization(OR=1.206,95%CI:1.057-1.489,P=0.002)were independent risk factors for the occurrence of symptomatic cerebral ischemia in ICVD patients.H-L deviation test showed that the constructed nomogram risk prediction model had a good fit(χ^(2)=9.362,P=0.295).Internal and external validation showed that the calibration curves for both the training and validation sets were consistent with the original curves,and the AUC value was were 0.871 and 0.864,respectively.Decision curve analysis showed that the model had a significant standardized clinical net benefit when the predicted risk threshold exceeded 0.01.Conclusion Ultrasonography is instructive in assessment of the presence o

关 键 词：脑缺血 颈动脉疾病 列线图 新生血管 

分 类 号：R743.3[医药卫生—神经病学与精神病学]