载脂蛋白B对急性脑梗死患者颅内动脉狭窄的预测价值分析  

Predictive value of apolipoprotein B in intracranial artery stenosis in patients with acute cerebral infarction

作　　者：孙兆远 司志华[1] 王爱华[1] Sun Zhaoyuan;Si Zhihua;Wang Aihua(Department of Neurology,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qianfoshan Hospital)&Shandong Institute of Neuroimmunology,Jinan 250013,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)神经病学、山东省神经免疫研究所,济南250013

出　　处：《神经疾病与精神卫生》2025年第2期123-130,共8页Journal of Neuroscience and Mental Health

基　　金：山东省重点研发计划(2019GSF108033)。

摘　　要：目的研究载脂蛋白B(ApoB)对急性脑梗死(ACI)患者颅内动脉狭窄的预测价值。方法回顾性收集2021年8月1日—2023年12月1日于山东省千佛山医院神经内科住院治疗的391例ACI患者的临床资料,根据颅内动脉狭窄程度将患者分为轻度狭窄组(n=223)、中度狭窄组(n=89)、重度狭窄组(n=79)。采用有序和二元Logistic回归分析颅内动脉狭窄程度的影响因素。建立模型列线图,绘制受试者工作特征(ROC)曲线、校准曲线、临床影响曲线(CIC)、决策曲线分析(DCA)进行模型预测效能的评估。采用净重新分类指数(NRI)和综合判别改善指数(IDI)进行不同预测模型的比较。结果轻、中、重度狭窄组患者高血压占比、糖尿病占比、高脂血症占比、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、ApoA1、ApoB水平比较,差异均有统计学意义(均P<0.05)。有序多因素Logistic回归分析显示,ApoB是ACI患者颅内动脉狭窄程度增加的独立危险因素(OR=10.350,95%CI:3.466~30.939,P<0.001)。二元多因素Logistic回归分析显示,ApoB分别与中度(OR=8.236,95%CI:2.378~28.528,P<0.001)和重度狭窄(OR=7.702,95%CI:2.122~28.633,P<0.05)独立相关。中重度狭窄组患者糖尿病与高脂血症的伴发率、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、ApoB水平均高于轻度狭窄组,差异均有统计学意义(均P<0.001)。二元多因素Logistic回归分析结果显示,ApoB是ACI患者颅内动脉中重度狭窄的独立危险因素(OR=21.417,95%CI:6.052~73.887,P<0.001)。将ApoB引入传统模型,绘制新型模型的列线图。ROC曲线显示,新型模型(AUC=0.702,敏感度=47.60%,特异度=87.00%)的预测价值要优于传统模型(AUC=0.660,敏感度=45.80%,特异度=82.10%)。校准曲线提示2种预测模型的预测校准曲线与标准曲线吻合度较高。DCA及CIC表明新型模型的临床净收益率要优于传统预测模型。新型模型相较于传统模型,NRI及IDI均有提高(NRI=0.455,P<0.001;IDIObjective To investigate the predictive value of apolipoprotein B(ApoB)for intracranial arterial stenosis in patients with acute cerebral infarction(ACI).Methods Clinical data of 391 patients with ACI in the Department of Neurology,Shandong Provincial Qianfoshan Hospital,from August 1,2021 to December 1,2023 were retrospectively collected.Patients were categorized according to the degree of intracranial artery stenosis into mild stenosis group(n=223),moderate stenosis group(n=89),and severe stenosis group(n=79).Factors influencing the degree of intracranial arterial stenosis were analyzed using ordered and binary Logistic regression.The assessment of model predictive efficacy was performed by building model nomogram,plotting receiver operating characteristic(ROC)curve,calibration curve,clinical impact curve(CIC),and decision curve analysis(DCA).Net reclassification index(NRI)and integrated discrimination improvement index(IDI)were used for the comparison of different predictive models.Results There were statistically significant differences in the proportions of hypertension,diabetes mellitus,hyperlipidemia,as well as the levels of low-density lipoprotein cholesterol,total cholesterol,triglyceride,ApoA1,and ApoB among the patients in the mild,moderate,and severe stenosis groups(all P<0.05).Ordered multifactorial Logistic regression analysis showed that ApoB was an independent risk factor for increased intracranial arterial stenosis in ACI patients[OR=10.350,95%CI(3.466,30.939),P<0.001].Binary multifactorial Logistic regression analysis showed that ApoB was independently associated with moderate stenosis[OR=8.236,95%CI(2.378,28.528),P<0.001]and severe stenosis[OR=7.702,95%CI(2.122,28.633),P<0.05],respectively.The concomitant rates of diabetes mellitus and hyperlipidemia,low-density lipoprotein cholesterol,total cholesterol,triglyceride,and ApoB levels of patients in moderate and severe stenosis group were higher than those in mild stenosis group,and the differences were all statistically significant(all P<0.001).B

关 键 词：载脂蛋白B 急性脑梗死 动脉狭窄 预测价值 

分 类 号：R743.33[医药卫生—神经病学与精神病学]