老年性中等量丘脑出血患者入院时基础资料对神经内镜微创术后预后预测列线图模型建立的研究

Study on the establishment of a nomogram model for the prognosis prediction of the elderly patients with moderate thalamic hemorrhage at the time of admission

目的:分析老年性中等量丘脑出血患者入院时基础资料对神经内镜微创术后预后的影响,并建立预测预后的列线图模型。方法:纳入2017年10月至2019年1月于我院诊治的320例老年性中等量丘脑出血患者作为模型组,另纳入2019年2月至2020年9月诊治的125例老年性中等量丘脑出血患者作为测试组。比较模型组不同预后患者的入院时基础资料,应用多因素Logistic回归模型分析患者预后的影响因素。应用R软件建立老年性中等量丘脑出血患者预后的列线图模型并进行验证,采用受试者工作特征(ROC)曲线分析该模型预测模型组、测试组患者预后情况的效能。结果:模型组患者随访1个月,预后良好262例(83.97%)。预后良好组的入院时格拉斯哥昏迷(GCS)评分、出血量明显低于预后不良组,两组的丘脑出血部位、分型、是否破入脑室差异有统计学意义(P<0.05)。Logistic回归分析显示,入院时GCS评分、出血量、丘脑出血部位、分型、是否破入脑室均是影响预后的危险因素(P<0.05)。列线图模型预测模型组与测试组的C-index分别为0.836和0.813,模型组的曲线下面积(AUC)为0.812(95%CI 0.690~0.935),测试组的AUC为0.808(95%CI 0.647~0.959)。结论:入院时GCS评分、出血量、丘脑出血部位、分型、是否破入脑室均是老年性中等量丘脑出血患者经神经内镜微创术后1个月发生预后不良的危险因素,以这5项指标建立的列线图模型具有良好的预后预测效能。

Objective:To analyze the impact of basic data on the prognosis of minimally invasive neuroendoscopic surgery in elderly patients with moderate thalamic hemorrhage,and establish a nomogram model for predicting the prognosis.Methods:320 elderly patients with moderate thalamic hemorrhage diagnosed and treated in our hospital from October 2017 to January 2019 were included as the model group.In addition,125 elderly patients with moderate thalamic hemorrhage who were diagnosed and treated from February 2019 to September 2020 were included as the test group.The basic data of patients with different prognosis in the model group were compared at the time of admission,and the multivariate Logistic regression model was used to analyze the factors affecting the prognosis of patients.The nomogram model of the prognosis of elderly patients with moderate thalamic hemorrhage was established and verified by R software.The receive operatine characteristic(ROC)curve was used to analyze the effectiveness of the model to predict the prognosis of the model group and the test group.Results:The model group was followed up for 1 month,and the prognosis was good in 262 cases(83.97%).The glasgow coma score(GCS)score and blood loss on admission of the good prognosis group were significantly lower than those of the poor prognosis group.There were statistically significant differences in the location,type and breakage of thalamic hemorrhage between the two groups(P<0.05).Logistic regression analysis showed that GCS score,bleeding volume,thalamic location,classification,and ventricle hemorrhage involvement were all risk factors affecting the prognosis(P<0.05).The nomogram model predicted that the C-index of the model group and the test group were0.836 and 0.813,respectively,the area under the curve(AUC)of the model group was 0.812(95%CI 0.690~0.935),and the AUC of the test group was 0.808(95%CI 0.647~0.959).Conclusion:GCS score,bleeding volume,thalamic hemorrhage location,type,and ventricle involved in hemorrhage upon admission are all risk factors for poor prognosis in elderly patients with moderate thalamic hemorrhage after neuroendoscopic minimally invasive surgery.The nomogram model established by these indicators has good predicting value.