重复经颅磁刺激治疗缺血性脑卒中上肢功能障碍疗效的影响因素及预测模型构建OA

Objective To explore the influencing factors of the efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of upper limb dysfunction after ischemic stroke,and to construct an efficacy prediction model and verify its clinical efficacy.Methods A total of 136 patients with upper limb dysfunction after ischemic stroke who received rTMS treatment and were admitted to Lishui Second People's Hospital from February 2022 to February 2024 were retrospectively enrolled.All patients completed 8 weeks of standardized rTMS treatment.According to the recovery of upper limb function after treatment,the patients were divided into poor efficacy group(31 cases)and good efficacy group(105 cases).Univariate and multivariate logistic regression analyses were used to screen the independent influencing factors of rTMS therapeutic efficacy,and the efficacy prediction model was constructed.The predictive efficacy of the model was evaluated by receiver operating characteristic(ROC)curve,internal validation and decision curve analysis.Results The scores of the simplified Fugl-Meyer Assessment(SF-FMA)scale at 2,4 and 8 weeks after treatment were significantly higher than those before treatment,with statistically significant differences(all P＜0.05).The proportions of patients with insufficient treatment cognition,negative treatment initiative,combined hypertension and smoking history in the poor efficacy group were significantly higher than those in the good efficacy group(all P＜0.05).Multivariate logistic regression analysis showed that sufficient treatment cognition and positive treatment initiative were independent protective factors for rTMS efficacy,while combined hypertension and smoking history were independent risk factors(all P＜0.05).The single and combined prediction models of treatment cognition,treatment initiative,history of hypertension and smoking history could effectively predict the efficacy of rTMS treatment,with the area under curve(AUC)values of 0.785,0.778,0.705,0.626 and 0.946,respectively.Internal calibration validation of the model showed that the calibration curve after deviation correction fitted well with the ideal curve,indicating good predictive efficacy of the model.Decision curve analysis showed that the net clinical benefit of the model remained positive within the clinical threshold probability range,which was significantly better than the reference lines of no intervention and full intervention.Conclusion Sufficient treatment cognition and positive treatment initiative are independent protective factors for the efficacy of rTMS upper limb rehabilitation in patients with ischemic stroke,while combined hypertension and smoking history are independent risk factors.The above four indicators are independent predictors of efficacy.The constructed prediction model based on them has excellent predictive performance,which can provide an objective quantitative reference for clinical evaluation of rTMS rehabilitation efficacy and formulation of individualized intervention strategies.