神经介入术后缺血性脑卒中患者复发的影响因素分析OA
Analysis of influencing factors of recurrence in patients with ischemic stroke after neurointerventional surgery
目的 探讨神经介入术后缺血性脑卒中复发影响因素,并构建列线图预测模型,为临床精准化风险分层与个体化干预策略制定提供循证依据.方法 对152 例行神经介入术的缺血性脑卒中患者进行≥1年的定期随访,根据是否复发将患者分为复发组和未复发组.比较两组患者临床资料的差异.通过 Logistic回归分析筛选出缺血性脑卒中复发影响因素,构建列线图预测模型,并进行内部验证.结果 复发组与未复发组高血压比率、脑血管狭窄程度、血管再通情况差异有统计学意义(均 P<0.05).二元 Logistic 回归分析显示,高血压、脑血管狭窄程度重是缺血性脑卒中复发独立危险因素(均 P<0.05),血管再通情况是缺血性脑卒中复发保护因素(P<0.05).高血压、脑血管狭窄程度、血管再通情况、列线图风险预测模型均可预测神经介入术后缺血性脑卒中复发,曲线下面积分别为0.676(95%CI:0.575～0.778)、0.711(95%CI:0.600～0.822)、0.662(95%CI:0.550～0.774)、0.850(95%CI:0.784～0.916).当取 cut-off 值时,各自灵敏度分别为 0.579、0.876、0.581、0.774,特异度分别为0.774、0.516、0.744、0.760.采用 Bootstrap 法(B=1000)对神经介入术后缺血性脑卒中复发预测模型实施内部验证,结果显示,经偏差校正后预测曲线接近理想状态,C-index 达到0.657,表明模型预测能力较强.此外,该模型决策曲线在0.00～0.80 阈值概率范围内,展现出净收益始终为正且优于两条无效参照线特点.结论 高血压、脑血管狭窄程度重是缺血性脑卒中复发独立危险因素,血管再通情况是缺血性脑卒中复发保护因素.基于这三项因素构建的风险预测模型预测能力和实用价值均较高,有助于评估缺血性脑卒中复发风险,改善患者预后.
Objective To explore the influencing factors of ischemic stroke recurrence after neurointerventional surgery,and to construct a nomogram prediction model,to provide evidence-based basis for clinical precise risk stratification and individualized intervention strategy formulation.Methods A total of 152 patients with ischemic stroke who underwent nerve intervention were followed up regularly for more than 1 years.The patients were divided into recurrence group and non-recurrence group according to whether they relapsed.The differences in clinical data between the two groups were compared.Logistic regression analysis was used to screen out the influencing factors of ischemic stroke recurrence,and a nomogram prediction model was constructed and verified internally.Results There were significant differences in the ratio of hypertension,the degree of cerebral vascular stenosis and vascular recanalization between the recurrent group and the non-recurrent group(all P<0.05).Binary Logistic regression analysis showed that hypertension and severe cerebral vascular stenosis were independent risk factors for recurrence of ischemic stroke(all P<0.05),and vascular recanalization was a protective factor for recurrence of ischemic stroke(P<0.05).Hypertension,degree of cerebral vascular stenosis,vascular recanalization,and nomogram risk prediction models could predict the recurrence of ischemic stroke after neurointervention,the area under the curve was 0.676(95%CI:0.575-0.778),0.711(95%CI:0.600-0.822),0.662(95%CI:0.550-0.774),and 0.850(95%CI:0.784-0.916),respectively.When the cut-off value was taken,the sensitivity was 0.579,0.876,0.581 and 0.774 respectively,and the specificity was 0.774,0.516,0.744 and 0.760 respectively.Bootstrap method(B=1 000)was used to verify the prediction model of ischemic stroke recurrence after neurointervention.The results showed that the prediction curve was close to the ideal state after bias correction,and the C-index reached 0.657,indicating that the model had strong predictive ability.In addition,the decision curve of the model showed that the net income was always positive and better than the two invalid reference lines in the range of 0.00 to 0.80 threshold probability.Conclusions Hypertension and severe cerebral vascular stenosis are independent risk factors for recurrence of ischemic stroke,and vascular recanalization is a protective factor for recurrence of ischemic stroke.The risk prediction model based on these three factors has high predictive ability and practical value,which is helpful to evaluate the risk of recurrence of ischemic stroke and improve the prognosis of patients.
赵波;刘丽;范德先
637200 南充,西充县人民医院神经内科637200 南充,西充县人民医院神经内科637200 南充,西充县人民医院神经内科
医药卫生
神经介入术缺血性脑卒中复发影响因素预测模型
neurointerventional surgeryrecurrent ischemic strokeinfluencing factorsprediction model
《临床神经病学杂志》 2026 (4)
269-274,6
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