中青年急性脑梗死机械取栓预后的Nomogram预测模型构建及临床效用分析  

Nomogram prediction model and clinical utility analysis of prognosis of mechanical thrombectomy for acute cerebral infarction in young and middle-aged people

作　　者：韩思 辛雪 马萍 谢晶 彭一鹏 HAN Si;XIN Xue;MA Ping;XIE Jing;PENG Yipeng(Department of Neurosurgery,Wuhan Red Cross Hospital,Wuhan Hubei 430000,China)

机构地区：[1]武汉市红十字会医院神经外科,湖北武汉430000 [2]武汉市普仁医院神经内科,湖北武汉430000

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期502-506,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的 探讨中青年急性脑梗死(ACI)机械取栓(MT)预后的影响因素,构建Nomogram预测模型。方法 选择中青年ACI患者100例,根据预后情况分为预后良好组(n=63)、预后不良组(n=37),收集并比较两组临床资料,中青年ACI患者MT预后不良的影响因素采用多因素Logistic回归分析。采用R版3.5.2中的“rms”软件包绘制ACI患者MT后预后不良风险的Nomogram预测模型,通过受试者工作特征(ROC)曲线评估所建立模型的诊断效率。结果 预后不良组患者糖尿病占比明显高于预后良好组(P<0.05)。预后不良组患者手术持续时间、急性生理学与慢性健康状况评分(APACHEⅡ评分)、入院时美国国立卫生研究院卒中量表评分(NIHSS评分)明显高于预后良好组(P<0.05)。与预后良好组比较,预后不良组患者甘油三酯(TG)、糖化血红蛋白(HbA1c)水平明显较高(P<0.05)。多因素Logistic回归分析显示,TG、HbA1c、糖尿病、手术持续时间、入院时NIHSS评分是中青年ACI患者MT预后不良的独立危险因素(P<0.05)。糖尿病、手术持续时间、入院时NIHSS评分、TG、HbA1c作为预测因子,构建Nomogram预测模型,ROC曲线验证Nomogram预测模型预测中青年ACI患者MT后预后不良的曲线下面积(AUC)为0.813(95%CI:0.726~0.900)(P<0.05)。内部验证结果显示,C-index为0.776,具有良好的一致性。结论 中青年ACI患者MT预后不良发生率约为37.00%,其中糖尿病、手术持续时间、入院时NIHSS评分高表达、TG高表达、HbA1c高表达是预后不良的危险因素,构建Nomogram预测模型在预测中青年ACI患者MT后预后不良价值较高,可帮忙筛选预后不良高危患者,帮助指导治疗方案及预测预后。Objective To analyze the risk factors for the prognosis of mechanical thrombolysis(MT) in acute cerebral infarction(ACI) in young and middle-aged patients and construct a Nomogram prediction model.Methods A total of100 cases of young and middle-agedpatients with ACI were conducted on this study.All patients were divided into two groups:good prognosis group(n=63) and poor prognosis group(n=37) according to Modified Rankin scale(mRS).The risk factors of poor prognosis of MT in young and middle-aged ACI patients were analyzed by multifactorial Logistic regression.A Nomogram prediction model of the risk of poor prognosis after MT in patients with ACI was developed using the "rms" software package in R version 3.5.2,and the diagnostic efficiency of the model was evaluated by the ROC curve.Results The percentage of diabetes mellitus,the duration of surgery,Acute Physiology and Chronic Health Status Score(APACHE II score),and National Institutes of Health Stroke Scale score(NIHSS score) at admission were significantly higher in the poor prognosis group than those of the good prognosis group(P<0.05).Triglyceride(TG) and glycosylated hemoglobin(HbA1c) levels of patients in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).Multifactorial Logistic regression analysis showed that diabetes mellitus,duration of surgery,NIHSS score at admission,TG,and HbA1c were risk factors for poor prognosis of MT in young and middle-aged ACI patients(P<0.05).Diabetes mellitus,duration of surgery,NIHSS score at admission,TG,and HbA1c were used as predictors to construct a Nomogram prediction model,and the ROC curve verified that the area under the curve(AUC) of the Nomogram prediction model for predicting poor prognosis after MT in young and middle-aged patients with ACI was 0.813(95% CI 0.726-0.900)(P<0.05).Internal validation showed a C-index of 0.776 and a good fit of the standard curve to the calibrated predictive curve in the calibration graph.Conclusion The incidence of poor prognosis of M

关 键 词：中青年 急性脑梗死 机械取栓 预后 Nomogram预测模型 效用 

分 类 号：R743.33[医药卫生—神经病学与精神病学]