急性缺血性脑卒中患者发生下肢深静脉血栓形成的影响因素及其风险预测列线图模型构建  

Influencing Factors of Lower Extremity Deep Venous Thrombosis in Patients with Acute Ischemic Stroke and Construction of Nomogram Model for Predicting Its Risk

作　　者：杜燕 王少敏[2] 杨玉芹[1] 鲁怡彤 DU Yan;WANG Shaomin;YANG Yuqin;LU Yitong(Department of Neurosurgery,the First People's Hospital of Lianyungang,Lianyungang 222000,China;Nursing Department,the First People's Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]江苏省连云港市第一人民医院神经外科,222000 [2]江苏省连云港市第一人民医院护理部,222000

出　　处：《实用心脑肺血管病杂志》2025年第4期25-32,共8页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省连云港市科协软课题研究立项项目(Lkxyb24170)。

摘　　要：目的 分析急性缺血性脑卒中(AIS)患者发生下肢深静脉血栓形成的影响因素,构建并验证其风险预测列线图模型。方法 选取2023年10月—2024年10月连云港市第一人民医院神经外科收治的AIS患者340例作为研究对象,采用随机数字表法按照7∶3比例将患者分为建模集237例和验证集103例。收集患者临床资料,根据下肢深静脉血栓形成发生情况将建模集患者分为血栓形成组(n=54)与非血栓形成组(n=183)。采用LASSO回归筛选AIS患者发生下肢深静脉血栓形成可能的影响因素;采用多因素Logistic回归分析探讨AIS患者发生下肢深静脉血栓形成的影响因素;采用rms程序包建立AIS患者发生下肢深静脉血栓形成的风险预测列线图模型;采用Bootstrap自举法进行1 000次重复抽样,计算一致性指数(CI);采用Hosmer-Lemeshow拟合优度检验评价该列线图模型在建模集和验证集中的拟合程度;绘制ROC曲线分析该列线图模型对建模集和验证集AIS患者发生下肢深静脉血栓形成的预测价值;绘制临床决策曲线分析该列线图模型在建模集和验证集中的临床获益。结果 非血栓形成组与血栓形成组年龄、有吸烟史者占比、有心血管疾病史者占比、有高脂血症史者占比、意识障碍发生率、格拉斯哥昏迷量表(GCS)评分、APTT、血浆纤维蛋白原(FIB)、D-二聚体、脂蛋白比较,差异有统计学意义(P<0.05)。LASSO回归分析结果显示,吸烟史、高脂血症史、D-二聚体、脂蛋白可能是AIS患者发生下肢深静脉血栓形成的影响因素(P<0.05)。多因素Logistic回归分析结果显示,吸烟史、高脂血症史、D-二聚体、脂蛋白为AIS患者发生下肢深静脉血栓形成的独立影响因素(P<0.05)。基于以上因素构建AIS患者发生下肢深静脉血栓形成的风险预测列线图模型,在建模集中其CI为0.99。Hosmer-Lemeshow拟合优度检验结果显示,在建模集和验证集中,该列线图模型拟合�Objective To investigate the influencing factors of lower extremity deep venous thrombosis in patients with acute ischemic stroke(AIS),and construct its risk prediction nomogram model.Methods A total of 340 AIS patients admitted to Department of Neurosurgery in the First People's Hospital of Lianyungang from October 2023 to October 2024 were selected as the research subjects.Patients were divided into modeling set(n=237)and validation set(n=103)in a ratio of 7∶3by the random number table method.Clinical data of the patients were collected,and patients in modeling set were divided into thrombosis group(n=54)and non-thrombosis group(n=183)according to the incidence of lower extremity deep venous thrombosis.LASSO regression was used to screen for possible influencing factors of lower extremity deep venous thrombosis in patients with AIS;multivariate Logistic regression analysis was used to explore the influencing factors of lower extremity deep venous thrombosis in patients with AIS;the nomogram model for predicting the risk of lower extremity deep venous thrombosis in patients with AIS was constructed by rms program package.The Hosmer-Lemeshow goodness of fit test was used to evaluate the fitting of the nomogram model in the modeling set and the validation set.ROC curve was drawn to analyze the predictive value of the nomogram model for lower extremity deep venous thrombosis in patients with AIS in the modeling set and the validation set.Clinical decision curve was drawn to assess the clinical benefit of the nomogram model in the modeling set and the validation set.Results There were significant differences in age,proportion of patients with stroke history,proportion of patients with cardiovascular disease history,proportion of patients with hyperlipidemia history,incidence of consciousness disorders,Glasgow Coma Scale(GCS)score,APTT,plasma fibrinogen(FIB),D-dimer and lipoprotein between non-thrombosis group and thrombosis group(P<0.05).The results of LASSO regression analysis showed that stroke history,hyperlipi

关 键 词：卒中 下肢深静脉血栓形成 影响因素分析 列线图 

分 类 号：R743[医药卫生—神经病学与精神病学]