脑血管介入术后支架内再狭窄的列线图预测模型构建OA
Construction of a nomogram prediction model for in-stent restenosis after cerebrovascular interventional surgery
目的 分析脑血管介入术后支架内再狭窄(ISR)发生的危险因素,并构建预测 ISR风险的列线图模型.方法 回顾性分析 2020 年 3 月至 2023 年 6 月在四川省宣汉县人民医院行脑血管介入术的307 例患者的资料,根据术后1 年内是否发生ISR 分成 ISR 组(52 例)和对照组(255例).比较两组一般信息、病变情况、手术指标及术前实验室指标,采用Logistic回归模型筛查术后 ISR 发生的危险因素,构建预测脑血管介入术后 ISR 风险的列线图模型,并对其预测效果予以验证.结果 307 例患者中,术后 1 年内 ISR 发生率为 16.94%(52/307).ISR 组吸烟、糖尿病、重度病变狭窄、支架长度>16 mm患者比例及低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)水平和对照组比较差异有统计学意义(P<0.05).Logistic回归模型分析结果显示吸烟(OR=4.515,95%CI=1.768～5.526)、糖尿病(OR=6.247,95%CI=2.813～8.180)、支架长度>16 mm(OR=2.872,95%CI=1.224～3.735)、LDL-C 升 高(OR=2.260,95%CI=1.330～3.838)、UA 升 高(OR=2.420,95%CI=1.780～4.289)是脑血管介入术后 ISR 发生的危险因素(P<0.05).构建脑血管介入术后ISR发生的列线图预测模型,内部验证显示,ROC曲线下面积为0.839(95%CI=0.769～0.910),敏感度、特异度分别为 80.80%、78.00%.预测模型的校准曲线显示模型预测概率与实际概率接近(斜率接近1).Hosmer-Lemeshow检验结果为χ2=10.026,P>0.05,校准度良好.结论 吸烟、糖尿病、支架长度>16 mm、LDL-C 升高、UA 升高是脑血管介入术后 ISR 的危险因素,根据这些因素构建的列线图预测模型可对脑血管介入术后ISR风险予以有效预测.
Objective To analyze the risk factors for in-stent restenosis(ISR)after cerebrovascular interventional surgery and to construct a nomogram model for predicting ISR risk.Methods A retrospective analysis was conducted on the data of 307 patients who underwent cerebrovascular interventional surgery at Xuanhan County People's Hospital from March 2020 to June 2023.Patients were divided into an ISR group(52 cases)and a control group(255 cases)based on whether ISR occurred within 1 year after surgery.General information,lesion characteristics,surgical indicators,and preoperative laboratory indicators of the two groups were compared.Logistic regression was used to identify risk factors for postoperative ISR.A nomogram model was constructed to predict ISR risk after cerebrovascular interventional surgery,and the predictive effect was verified.Results Among 307 patients,the incidence of ISR within 1 year after surgery was 16.94%(52/307).The proportions of patients with smoking,diabetes,severe lesion stenosis,stent length>16 mm,and the levels of low-density lipoprotein cholesterol(LDL-C)and uric acid(UA)in the ISR group were significantly different from those in the control group(all P<0.05).Logistic regression analysis showed that smoking(OR=4.515,95%CI=1.768-5.526),diabetes(OR=6.247,95%CI=2.813-8.180),stent length>16 mm(OR=2.872,95%CI=1.224-3.735),elevated LDL-C(OR=2.260,95%CI=1.330-3.838),and elevated UA(OR=2.420,95%CI=1.780-4.289)were risk factors for ISR after cerebrovascular interventional surgery(all P<0.05).An model for predicting the occurrence of ISR after cerebrovascular intervention was constructed.Internal validation revealed an area under the ROC curve of 0.839(95%CI=0.769-0.910),with a sensitivity of 80.80%and a specificity of 78.00%.Calibration curve of the model indicated that the predicted probability was close to the actual probability(slope approaching 1).The Hosmer-Lemeshow test yielded χ2=10.026,P>0.05,indicating good calibration.Conclusion Smoking,diabetes,stent length>16 mm,elevated LDL-C,and elevated UA are risk factors for ISR after cerebrovascular interventional surgery.The nomogram prediction model constructed based on these factors can effectively predict the risk of ISR after cerebrovascular interventional surgery.
周如江;孙建萍;刘海
636150 达州,四川省宣汉县人民医院神经内科636150 达州,四川省宣汉县人民医院神经内科636150 达州,四川省宣汉县人民医院神经内科
脑血管介入术支架内再狭窄危险因素列线图预测模型
Cerebrovascular interventional surgeryIn-stent restenosisRisk factorsNomogram prediction model
《心脑血管病防治》 2026 (8)
20-24,5
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