急性脑梗死患者侧支循环建立的影响因素及其列线图模型构建

Influencing factors of establishment of collateral circulation in patients with acute ischemic stroke and its construction of nomogram model

目的观察急性脑梗死(Acute cerebral infarction,ACI)患者侧支循环建立的影响因素,并构建列线图模型。方法回顾性分析本院2019年1月-2021年1月收治的128例ACI患者的临床资料,评估侧支循环建立情况,将患者分为有侧支循环组和无侧支循环组,采用Logistic回归分析检验ACI患者侧支循环建立的影响因素,应用R语言建立预测ACI患者无侧支循环的列线图模型,采用Bootstrap法进行模型验证,并探讨列线图模型对ACI患者无侧支循环的预测效能。结果128例ACI患者中83例有侧支循环,45例无侧支循环;比较无侧支循环组和有侧支循环组基线资料后经Logistic回归分析显示,收缩压高、有糖尿病史、有高脂血症史、有吸烟史、脑动脉轻度狭窄是ACI患者无侧支循环建立的风险因子(OR>1,P<0.05);建立预测ACI患者无侧支循环的列线图模型,同时使用Bootstrap内部验证法对ACI患者无侧支循环的列线图模型进行验证,校准曲线几乎和Y=X直线重合,模型校准度良好;对列线图模型进行验证,绘制受试者工作曲线(Receiver operator curve,ROC)发现,列线图模型预测ACI患者无侧支循环发生风险的曲线下面积(Area of the under curve,AUC)>0.80,有一定预测价值。结论ACI患者无侧支循环建立与多种因素有关,构建列线图风险模型具有良好的区分度和精准度,并有较好的预测效能。

Objective To observe the influencing factors of establishment of collateral circulation in patients with acute ischemic stroke(AIS),and to construct the nomogram model.Methods 128 patients with ACI treated in the hospital from January 2019 to January 2021 were enrolled to evaluate collateral circulation.The patients were divided into collateral circulation group and without collateral circulation group.Logistic regression analysis was used to examine the influencing factors of collateral circulation in AIS patients.R language was used to establish a nomogram model for predicting without collateral circulation in AIS patients,Bootstrap method was used to verify the model,and the predictive efficiency of nomogram model on without collateral circulation in ACI patients was explored.Results Of 128 ACI patients,83 had collateral circulation and 45 did not have collateral circulation;after comparing the baseline data of without collateral circulation group and collateral circulation group,through Logistic regression analysis,the results showed that high systolic blood pressure,history of diabetes mellitus,history of hyperlipidemia,smoking history and mild cerebral arterial stenosis were risk factors for AIS patients without collateral circulation(OR>1,P<0.05).A nomogram model for predicting without collateral circulation in AIS patients was established.At the same time,Bootstrap internal validation method was used to verify the nomogram model of AIS patients without collateral circulation,the calibration curve almost coincides with the Y=X line,and the calibration degree of the model was good;and the nomogram model was verified,the receiver operating curve(ROC)was drawn and found that the area under the curve(AUC)of nomogram model for predicting the risk of without collateral circulation in AIS patients was>0.80,which had certain predictive value.Conclusion The establishment of without collateral circulation in AIS patients is related to many factors,the established nomogram risk model has good discrimination and accuracy,and has good predictive efficiency,which is helpful to provide a feasible tool to predict without collateral circulation.