缺血性脑卒中3年复发危险因素的Cox回归分析及预测模型的构建

Cox regression analysis of risk factors and establishment of prediction model for recurrent acute ischemic stroke in 3-years follow-up

目的探讨缺血性脑卒中3年复发的危险因素并建立Cox比例风险回归模型，构建能够预测3年内复发的个体预后指数方程。方法前瞻性收集2013年1月1日至2013年12月31日华北理工大学附属医院神经内科确诊的1058例初发缺血性脑卒中患者为研究对象，同时随访患者的复发情况，于2016年1月1日完成随访工作，应用Kaplan—Meier法进行复发率分析，应用Cox比例风险回归模型对影响患者复发的危险因素进行单因素和多因素分析，绘制ROC曲线并确定截断点，构建预测3年内复发的个体预后指数方程。结果随访期间共184例患者复发，患者1年复发率为29．9／人年，2年复发率为46．6／人年，3年复发率为52．7／人年；经Cox比例风险回归模型单因素及多因素分析显示：年龄（X1）（RR=1．303；95％CI：1．019～1．666），心脏病史（X2）（RR=1．788；95％CI：1．127～2．836），高血压病史（X3）（RR=1．897；95％CI：1．097～3．280），糖尿病史（x4）（RR=1．674；95％CI：1．015—2．760），总胆固醇（x5）（RR=2．136；95％6＇1：1．396～3．266）是影响患者复发的独立危险因素，建立的复发模型的个体预后指数（PrognosisIndex，PI）为：PI=0．265X1＋0．581X2＋0．640X3＋0．515X4＋0．759X5。结论年龄、心脏病史、高血压病史、糖尿病史和总胆固醇是缺血性脑卒中患者中远期复发的独立危险因素，并成功建立能够预测3年内复发的个体预后指数方程。

Objective To investigate the risk factors and establish the Cox＇s regression model and the personal prognosis index for the recurrence of ischemic stroke in S-year follow-up. Methods 1 058 pa- tients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013. Cases were followed up since the onset of ischemic stroke. The follow-up was finished in January 1,2016. Ka- plan-Meier methods were used for recurrence rate description. Monovariant and multivariate Cox＇s proportion- al hazard regression model were used to analyze risk factors associated with recurrence. Thus, a recurrence model was set up. Results During the period of follow-up, 184 cases relapsed. The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,S-year recurrence rate was 52.7 person- year. Monovariant and multivariant Cox＇s proportional hazard regression model showed that the independent risk factors associated with recurrence were age（ X1 ） （RR= 1.303 ;95%CI： 1.019- 1.666）history of heart disease（X2） （RR= 1.788 ;95%C1：1.127 ~ 2.836） ,hypertension（X3） （RR= 1.897 ;95% CI： 1.097- 3.280）, dia- betes（X4） （RR= 1.674;95%CI： 1.015-2.760） ,total cholesterol（X5） （RR= 2.136;95%CI： 1.396-3.266）. The personal prognosis index （PI）of recurrence model was as the following： PI = 0.265X1 ＋0.581X2＋ 0.640X3＋0.515X4＋0.759X5. Conclusions Age,history of heart disease,hypertension,disease progression, and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke. The recur- rence model and the personal prognosis index equation are successful constructed.