前循环大血管闭塞型急性缺血性脑卒中患者机械取栓术后预后不良的影响因素分析及其风险预测列线图模型构建  

Influencing Factors of Poor Prognosis in Patients with Acute Ischemic Stroke with Anterior Circulation Macrovascular Occlusion Type after Mechanical Thrombectomy and Construction of Its Risk Prediction Nomogram Model

作　　者：陈英道 李国辉 张岐平 李海宁 梁炳松 饶源 陈小玲 李育英 CHEN Yingdao;LI Guohui;ZHANG Qiping;LI Haining;LIANG Bingsong;RAO Yuan;CHEN Xiaoling;LI Yuying(Department of Neurology,Wuzhou Gongren Hospital,Wuzhou 543000,China)

机构地区：[1]广西壮族自治区梧州市工人医院神经内科,543000

出　　处：《实用心脑肺血管病杂志》2025年第5期52-58,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题项目(Z-D20221713);梧州市科技计划项目(202302094)。

摘　　要：目的探讨前循环大血管闭塞型急性缺血性脑卒中(AIS)患者机械取栓术(MT)后预后不良的影响因素,并构建其风险预测列线图模型。方法选取2021年6月—2023年9月在梧州市工人医院接受MT的158例前循环大血管闭塞型AIS患者作为研究对象。采用随机数字表法按7∶3的比例将患者分为建模集(n=110)和验证集(n=48)。收集患者的临床资料,根据预后情况将建模集患者分为不良组和良好组。采用多因素Logistic回归分析探讨前循环大血管闭塞型AIS患者MT后预后不良的影响因素,基于上述影响因素构建风险预测列线图模型,分别采用ROC曲线、Hosmer-Lemeshow拟合优度检验分析该列线图模型对建模集、验证集患者MT后预后不良的预测价值及一致性,绘制临床决策曲线以评价该列线图模型的临床获益。结果110例建模集患者中有42例患者预后不良,预后不良发生率为38.18%。不良组与良好组高血压发生率、入院时Alberta卒中项目早期CT评分(ASPECTS)、入院时NIHSS评分、侧支循环代偿情况、术后并发脑出血者占比比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压、入院时NIHSS评分升高、侧支循环代偿较差、术后并发脑出血是前循环大血管闭塞型AIS患者MT后预后不良的危险因素,入院时ASPECTS升高是其保护因素(P<0.05)。基于多因素Logistic回归分析结果构建前循环大血管闭塞型AIS患者MT后预后不良的风险预测列线图模型。ROC曲线分析结果显示,该列线图模型预测建模集、验证集前循环大血管闭塞型AIS患者MT后预后不良的AUC分别为0.940〔95%CI(0.899~0.981)〕、0.964〔95%CI(0.918~0.999)〕。Hosmer-Lemeshow拟合优度检验结果显示,该列线图模型在建模集、验证集中的拟合程度均较好(χ^(2)=7.864,P=0.716;χ^(2)=6.305,P=0.658)。决策曲线分析结果显示,当阈值概率为0.04~0.94、0.08~0.96时,该列线图模型在建模集�Objective To investigate the influencing factors of poor prognosis in patients with acute ischemic stroke(AIS)with anterior circulation macrovascular occlusion type after mechanical thrombectomy(MT),and construct its risk prediction nomogram model.Methods From June 2021 to September 2023,158 cases of AIS patients with anterior circulation macrovascular occlusion type who underwent MT in Wuzhou Gongren Hospital were selected as study objects.The patients were separated into modeling set(n=110)and validation set(n=48)according to 7∶3 by random number table method.Clinical data of patients were collected.After 90 days of follow-up,patients in modeling set were divided into poor group and good group.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with AIS with anterior circulation macrovascular occlusion type after MT,the nomogram model of the risk prediction was constructed based on the above factors.ROC curve and Hosmer-Lemeshow goodness-of-fit test were used to analysis and evaluate the predictive value and consistency of nomogram model for poor prognosis in patients with AIS with anterior circulation macrovascular occlusion type after MT,respectively,and decision curve was drawn to evaluate the clinical benefit of the nomogram model.Results In 110 patients in modeling set,42 cases occurred poor prognosis,with an incidence of poor prognosis of 38.18%.There were significant differences of incidence of hypertension,Alberta Stroke Program Early CT Score(ASPECTS)at admission,NIHSS score at admission,collateral circulation compensation,and incidence of postoperative cerebral hemorrhage between poor group and good group(P<0.05).Multivariate Logistic regression analysis results showed that,hypertension,lower NIHSS score at admission,poor collateral circulation compensation,postoperative cerebral hemorrhage were risk factors of poor prognosis in patients with AIS with anterior circulation macrovascular occlusion type after MT,and higher ASPECTS was the

关 键 词：缺血性卒中 机械取栓术 预后 影响因素分析 列线图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]