个体化预测脑梗死偏瘫患者下肢深静脉血栓形成的诺莫图模型建立与应用  

Establishment and application of nomogram model for individualized prediction of deep venous thrombosis of lower limbs in patients with cerebral infarction and hemiplegia

作　　者：朱红 龚柳盛 张琳 傅慧 蒋玉婷 戢艳丽 Zhu Hong;Gong Liusheng;Zhang Lin;Fu Hui;Jiang Yuting;Ji Yanli(Department of Neurology,the People's Hospital of Jianyang City,Sichuan 641421,China)

机构地区：[1]简阳市人民医院神经内科,四川641421

出　　处：《脑与神经疾病杂志》2025年第1期59-64,共6页Journal of Brain and Nervous Diseases

基　　金：2020年四川省医学(青年创新)科研课题(Q20228)。

摘　　要：目的探究个体化预测脑梗死偏瘫患者下肢深静脉血栓形成(DVT)的诺莫图模型建立与应用。方法选取简阳市人民医院2020年1月-2023年12月住院的236例脑梗死偏瘫患者,根据有无合并DVT的情况,将其分为下肢DVT组患者115例和无下肢DVT组患者121例,应用Logistic回归分析其影响因素。根据影响因素构建诺莫图模型,采用受试者工作特征(ROC)曲线、校准曲线验证诺莫图模型的预测效能。结果236例脑梗死偏瘫患者中,合并下肢者DVT115例,占比48.73%;在两组患者中,体质量指数、病程、性别、冠心病史、饮酒史和吸烟史差异均无统计学意义(P>0.05),年龄、高血压、糖尿病、血脂、血液高凝及意识障碍的发生率均高于未患下肢DVT的患者(P<0.05);通过Logistic回归分析,发现脑梗死偏瘫患者下肢DVT的发生与患者年龄、高血压、糖尿病、高血脂、血液高凝、意识障碍有关(OR>1,P<0.05);绘制ROC曲线,结果显示,年龄、高血压、糖尿病、高血脂、血液高凝、意识障碍对于脑梗死偏瘫患者下肢DVT具有良好的预测价值;对诺莫图模型进行Bootstrap重复抽样1000次,获得校准曲线,计算的C-index值为0.876;绘制ROC曲线,对脑梗死偏瘫患者下肢DVT的诺莫图模型进行评价,AUC为0.882(95%CI:0.833~0.931)。结论脑梗死偏瘫患者下肢DVT的独立影响因素是年龄、高血压、糖尿病、高血脂、血液高凝、意识障碍,基于影响因素构建的诺莫图模型具有较高的参考效能。Objective To explore the establishment and application of nomogram model for individualized prediction of deep vein thrombosis(DVT)in patients with cerebral infarction and hemiplegia.Methods 236 patients with cerebral infarction and hemiplegia hospitalized in Jianyang People's Hospital from January 2020 to December 2023 were divided into 115 patients with DVT and 121 patients without DVT,and the influencing factors were analyzed by Logistic regression.According to the influencing factors,the Nomoto prediction model was constructed,and the predictive efficiency of the Nomoto model was verified by the receiver's operating characteristic(ROC)curve and calibration curve.Results Among 236 patients with cerebral infarction and hemiplegia admitted to the hospital,115 cases were complicated with DVT of lower limbs,accounting for 48.73%.There was no significant difference in body mass index,course of disease,sex,history of coronary heart disease,drinking history and smoking history between the two groups(P>0.05),and the incidence of age,hypertension,diabetes,blood lipid,hypercoagulability and disturbance of consciousness were higher than those of patients without DVT of lower limbs(P<0.05).Through Logistic regression analysis,it was found that the occurrence of DVT in lower limbs of patients with cerebral infarction was related to their age,hypertension,diabetes,hyperlipidemia,hypercoagulability and disturbance of consciousness(OR>1,P<0.05).The ROC curve is drawn.The results show that age,hypertension,diabetes,hyperlipidemia,hypercoagulability and disturbance of consciousness have good predictive value for deep venous thrombosis of lower limbs in patients with cerebral infarction and hemiplegia.Bootstrap repeated sampling was carried out for 1000 times to obtain the calibration curve,and the calculated C-index value was 0.876.The ROC curve was drawn to evaluate the Nomogram model of deep venous thrombosis in patients with cerebral infarction and hemiplegia,and the AUC was 0.882(95%Cl:0.833-0.931).Conclusion Age,hypertensi

关 键 词：脑梗死 偏瘫 下肢深静脉血栓 血液高凝 

分 类 号：R743.32[医药卫生—神经病学与精神病学]