LVIS支架治疗症状性颅内动脉粥样硬化性狭窄术后复发的风险预警模型及防控措施  

Risk Early Warning Model and Prevention and Control Measures for Recurrence of Intracranial Anterior Circulation Atherosclerotic Stenosis Treated with LVIS Stent

作　　者：李文燕 刘梓柠 郭园园[1] 李光辉[1] 刘永贵[1] LI Wenyan;LIU Zining;GUO Yuanyuan;LI Guanghui;LIU Yonggui(Emergency Interventional Operation Room,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊介入手术室,河南郑州450000

出　　处：《河南医学研究》2025年第7期1205-1211,共7页Henan Medical Research

基　　金：2022年河南省医学科技攻关联合共建项目(LHGJ20220406)。

摘　　要：目的分析LVIS支架治疗症状性颅内动脉粥样硬化性狭窄(sICAS)术后复发的危险因素,建立列线图风险预警模型,运用内部数据、外部数据加以验证,并探讨术后复发的防控措施。方法选取2020年4月至2024年1月郑州大学第一附属医院收治的297例sICAS患者,均接受LVIS支架治疗。分析术后1 a内患者复发情况,根据术后是否复发分为复发组(40例)与未复发组(257例)。比较复发组、未复发组患者临床资料,通过单因素、多因素logistic回归分析LVIS支架治疗后复发的危险因素,构建列线图风险预警模型,并对模型预测价值加以验证。结果复发组年龄≥60岁占比、吸烟史占比、糖尿病占比、高血压占比、血脂异常占比、血管狭窄程度≥70%占比、支架长度≥30 mm占比、支架直径<4.5 mm占比、未规范用药占比及甘油三酯(TG)、超敏C反应蛋白(hs-CRP)、脂蛋白a[LP(a)]均高于未复发组,差异有统计学意义(P<0.05);经logistic回归分析发现,年龄≥60岁、糖尿病、高血压、血脂异常、支架长度≥30 mm、支架直径<4.5 mm、未规范用药、TG、LP(a)是LVIS支架治疗颅内前循环sICAS患者术后复发的危险因素;受试者工作特征(ROC)曲线分析显示,该模型的曲线下面积(AUC)为0.921(95%CI:0.875~0.968);校准曲线、决策曲线显示该模型预测效能、准确性较高。结论颅内前循环sICAS患者经LVIS支架治疗后复发的危险因素为年龄≥60岁、糖尿病、高血压、血脂异常、支架长度≥30 mm、支架直径<4.5 mm、未规范用药、TG、LP(a),基于上述危险因素构建的列线图风险预警模型预测效能、准确性较高,可据此针对性制定术后复发防控措施,以降低术后复发率。Objective To analyze the risk factors for recurrence of symptomatic intracranial atherosclerosis stenosis(sICAS)after treatment with LVIS stent,establish a nomogram risk warning model,validate it using internal and external data,and explore prevention and control measures for postoperative recurrence.Methods A total of 297 patients with sICAS who were treated in the First Affiliated Hospital of Zhengzhou University from April 2020 to January 2024 were selected and all received LVIS stent treatment.The recurrence of patients within one year after surgery was analyzed,and they were divided into a recurrent group(40 cases)and an unrecurred group(257 cases)based on whether or not they had recurred.The clinical data of patients in the recurrence group and the non-recurrence group were compared,and the risk factors for postoperative recurrence were analyzed by unifactorial and multifactorial logistic regression,and the risk warning model of the column-line diagram was constructed,and the predictive value of the model was verified.Results The proportion of patients aged≥60 years,the proportion of patients with a history of smoking,the proportion of patients with diabetes,the proportion of patients with hypertension,the proportion of patients with abnormal blood lipids,the proportion of patients with vascular stenosis≥70%,the proportion of patients with stent length≥30 mm,the proportion of patients with stent diameter<4.5 mm,the proportion of patients with non-standardized medication use,and triglycerides(TG),high-sensitivity C-reactive protein(hs-CRP),lipoprotein(a)[LP(a)]were higher in the recurrent group than those in the non-recurrent group,and the differences were statistically significant(P<0.05).The results of logistic regression analysis showed that age≥60 years,diabetes,hypertension,dyslipidemia,stent length≥30 mm,stent diameter<4.5 mm,non-standardized medication,TG,and LP(a)were risk factors for LVIS stent recurrence in patients with sICAS after treatment.Receiver operating characteristic(ROC)curve an

关 键 词：颅内动脉粥样硬化性狭窄 LVIS支架置入术 术后复发 列线图预警模型 模型验证 防控措施 

分 类 号：R743.3[医药卫生—神经病学与精神病学]