基于Lasso-Logistic回归方程探究轻型缺血性脑卒中溶栓后转归的危险因素  

Risk factors for outcome after thrombolysis in mild ischemic stroke based on Lasso-Logistic regression equation

作　　者：张宏[1] 乔子梅 陈彭[1] 朱江[1] 柴玉梅[1] 李扬 ZHANG Hong;QIAO Zimei;CHEN Peng;ZHU Jiang;CHAI Yumei;LI Yang(Τhe First Hospital of Yulin,Yulin 719000,China)

机构地区：[1]榆林市第一医院,陕西榆林719000

出　　处：《中国实用神经疾病杂志》2024年第12期1504-1509,共6页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省重点研发计划项目(编号:2019SF-078)。

摘　　要：目的探讨轻型缺血性脑卒中(MIS)溶栓后转归的危险因素。方法选取2022-07—2023-07榆林市第一医院收治的191例MIS患者为研究对象,根据发病3个月后改良Rankin量表(mRS)评分分为转归良好组和转归不良组,比较2组一般资料、实验室指标等,采用Lasso进行数据降维、变量筛选,Logistic回归方程分析MIS溶栓后转归的影响因素,构建列线图模型,以受试者工作特征(ROC)曲线检验列线图模型预测的准确性,同时基于列线图模型建立危险分层系统。结果MIS患者发病3个月后转归不良发生率为32.08%。Lasso-Logistic回归方程显示,早期神经功能恶化、CX3C趋化因子配体1(CX3CL1)、CX3C趋化因子受体-1(CX3CR1)、大血管中重度狭窄或闭塞、肠道菌群失调、糖尿病均是MIS溶栓后转归的影响因素(P<0.05)。列线图模型预测MIS溶栓后转归不良的AUC为0.876,敏感度、特异度分别为100.00%、79.00%。基于列线图模型个体预测得分将187例患者分为低风险、中等风险、高风险,发病3个月后转归不良率分别为14.04%、22.86%、60.00%。结论MIS患者溶栓后转归的危险因素涉及肠道菌群失调、糖尿病、CX3CR1、CX3CL1等,据此构建列线图模型预测效能较好,有助于指导临床诊治。Objective To investigate the risk factors for outcome after thrombolysis in mild ischemic stroke(MIS).Methods A total of 191 patients with MIS admitted to the First Hospital of Yulin from July 2022 to July 2023 were selected as research objects and were divided into the good outcome group and the poor outcome group according to the modified Rankin scale(mRS)score 3 months after the onset of the disease.General data and laboratory indicators of the two groups were compared,and data dimension reduction and variable screening were performed by Lasso.Logistic regression equation was used to analyze the factors affecting the outcome after thrombolysis of mild ischemic stroke,and a columbaric model was constructed.The accuracy of the columbaric model was tested by receiver operating characteristic(ROC)curve,and a risk stratification system was established based on the columbaric model.Results The incidence of adverse outcomes in MIS patients was 32.08%after 3 months.Lasso-Logistic regression equation showed that early neurological deterioration,CX3CL1,CX3CR1,moderate to severe stenosis or occlusion of large blood vessels,intestinal flora disturbance,and diabetes were all influencing factors for the outcome after thrombilysis of MIS(P<0.05).The AUC of MIS after thrombolysis was 0.876,and the sensitivity and specificity were 100.00%and 79.00%,respectively.Totally 187 patients were divided into low risk,medium risk and high risk based on the individual prediction score of the nomogram model,and the outcome failure rates after 3 months were 14.04%,22.86%and 60.00%,respectively.Conclusion The risk factors of MIS patients after thrombolysis involve intestinal flora disturbance,diabetes,CX3CR1,CX3CL1,etc.The prediction efficiency of the nematic model is good,which is helpful to guide clinical diagnosis and treatment.

关 键 词：轻型缺血性脑卒中 溶栓 转归 危险因素 列线图模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]