急性缺血性脑卒中患者预后影响因素分析及列线图模型构建  

Influencing factors for prognosis of patients with acute ischemic stroke and construction of a nomogram model

作　　者：任永清 陈淑良[1] 刘嘉婧 郭彦娇 REN Yongqing;CHEN Shuliang;LIU Jiajing;GUO Yanjiao(Nursing Department,the Second Affiliated Hospital of Dalian Medical University,Dalian 116027,China;不详)

机构地区：[1]大连医科大学附属第二医院护理部,116027 [2]山东第一医科大学附属省立医院麻醉手术科

出　　处：《浙江医学》2025年第7期682-687,共6页Zhejiang Medical Journal

基　　金：大连东软信息学院-大连医科大学附属第二医院“集思融智-医工交叉”联合基金项目(LH-JSRZ-202207)。

摘　　要：目的探讨影响急性缺血性脑卒中(AIS)患者预后的因素,构建列线图模型并评估其预测价值。方法回顾性选取2021年1月至2022年4月大连医科大学附属第二医院收治的983例AIS患者,依据出院90 d改良Rankin量表(mRS)评分将患者分为预后不良(mRS≥3分)组(273例)和对照(mRS<3分)组(710例)。比较两组患者临床资料,采用单因素和二元logistic回归分析AIS患者预后的独立影响因素;根据这些独立影响因素构建列线图模型,绘制ROC曲线和校准曲线对列线图模型的诊断效能进行评价。结果二元logistic回归分析显示,性别(OR=0.675,95%CI:0.477~0.956),年龄(OR=1.029,95%CI:1.014~1.045),糖化血红蛋白(HbA1C)(OR=1.597,95%CI:1.115~2.288),入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.285,95%CI:1.231~1.342)和应激性高血糖比值(SHR)(OR=15.329,95%CI:1.157~203.057)是AIS患者预后的独立影响因素。ROC曲线分析表明,基于以上指标建立的列线图模型预测患者预后的AUC为0.834,校准曲线显示该模型具有良好的区分度及一致性。结论性别、年龄、HbA1C、入院时NIHSS评分、SHR与AIS患者预后有关,基于上述指标建立的列线图模型对预测AIS患者预后不良有较高的诊断效能。Objective To explore the factors influencing the prognosis of patients with acute ischemic stroke(AIS)to construct a nomogram model and evaluate its predictive value.Methods A total of 983 AIS patients admitted to the Second Affiliated Hospital of Dalian Medical University from January 2021 to April 2022 were retrospectively selected.Based on the modified Rankin Scale(mRS)scores at 90 days post-discharge,the patients were divided into a poor prognosis group(mRS≥3,n=273)and a control group(mRS<3,n=710).Clinical data were compared between the two groups.Univariate and binary logistic regression analyses were conducted to identify independent influencing factors for the prognosis of AIS patients.A nomogram model was constructed based on these independent factors,and ROC curves and calibration curves were plotted to evaluate the diagnostic performance of the model.Results Binary logistic regression analysis revealed that gender(OR=0.675,95%CI:0.477-0.956),age(OR=1.029,95%CI:1.014-1.045),glycosycated hemoglobin(HbA1C)(OR=1.597,95%CI:1.115-2.288),National Institutes of Health Stroke Scale(NIHSS)score at admission(OR=1.285,95%CI:1.231-1.342),and stree hyperglycemia ratio(SHR)(OR=15.329,95%CI:1.157-203.057)were independent factors influen-cing the prognosis of AIS patients.ROC curve analysis demonstrated that the nomogram model,constructed based on these indicators,had an AUC of 0.834 for predicting patient prognosis.The calibration curve indicated that the model exhibited excellent discrimination and consistency.Conclusion Gender,age,HbA1C,NIHSS score at admission,and SHR are associated with the prognosis of AIS patients.The nomogram model constructed based on these indicators demonstrates high diagnostic efficacy in predicting poor prognosis in AIS patients.

关 键 词：急性缺血性脑卒中 糖化血红蛋白 应激性高血糖比值 改良Rankin量表评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]