高龄轻型脑卒中患者溶栓治疗后发生早期神经功能恶化的危险因素及列线图风险预测模型

Occurrence of early neurological deterioration afteRthrombolysis therapy in elderly patients with mild stroke:risk factors and nomogram model of risk prediction

目的探讨高龄轻度脑卒中患者溶栓治疗后发生早期神经功能恶化(END)的危险因素,并建立列线图风险预测模型。方法回顾性分析165例高龄轻度脑卒中患者的临床资料,根据阿普酶溶栓治疗后是否发生END分为END组26例和无END组139例。采用Logistic回归模型分析高龄轻型脑卒中患者溶栓后发生END的独立危险因素。纳入独立危险因素建立列线图预测模型,并对模型的预测性及准确度进行验证。结果多因素Logistic回归分析结果显示,溶栓时存在高血糖、白细胞计数升高、颈动脉狭窄、血小板计数升高为高龄轻型脑卒中患者溶栓治疗后发生END的独立危险因素(均P<0.05)。基于上述4项危险因素建立预测高龄轻型脑卒中患者溶栓治疗后发生END的列线图模型,验证结果提示该模型预测值与实测值基本一致,预测能力较好,C-index指数高达0.857(95%CI:0.826,0.888),模型预测的准确度为中等。结论溶栓时合并高血糖、白细胞计数升高、颈动脉狭窄、血小板计数升高的高龄轻度脑卒中患者溶栓治疗后发生END的风险增大,临床上对该类患者进行溶栓治疗时应综合评估上述因素;采用危险因素所建立的列线图模型预测的准确度为中等,对预测高龄轻型脑卒中患者溶栓治疗后发生END的风险具有较高的临床应用价值。

Objective To explore the risk factors of developing early neurological deterioration(END)afteR thrombolysis therapy in elderly patients with mild stroke,and to establish a nomogram model of risk prediction.Methods The clinical data of 165 elderly patients with mild stroke were analyzed retrospectively,and the patients were divided into END group(n=26)and non-END group(n=139)according to the incidence of END afteR thrombolysis therapy with alteplase.Logistic regression model was used to analyze the independent risk factors foRdeveloping END afteRthrombolysis in elderly patients with mild stroke.The independent risk factors were enrolled to establish the nomogram prediction model.In addition,a validation was performed on the predictability and accuracy of the model.Results The results of multivariate Logistic regression analysis revealed that hyperglycemia,increased WBC count,carotid artery stenosis,and increased platelet count during thrombolysis were the independent risk factors foRdeveloping END in elderly patients with mild stroke afteR thrombolysis treatment(all P<0.05).The nomogram model of predicting the incidence of END in elderly patients with mild stroke afteRthrombolysis treatment was developed based on the fouRrisk factors mentioned above,the validation results indicated that the model had a predictive value basically consistent with the measured value,exhibited a preferable predictive poweRand moderate predictive accuracy,and the C-index index was as high as 0.857(95%CI:0.826,0.888).Conclusion Elderly patients with mild stroke with concomitant hyperglycaemia,increased WBC count,carotid artery stenosis,and increased platelet count during thrombolysis have increased risk of developing END afteRthrombolysis treatment.These patients,clinically,should receive the comprehensive assessment on the aforementioned factors during thrombolysis treatment.The nomogram model established based on the risk factors yields a moderate accuracy,having a relatively high clinical application value in predicting the risk of developing END in elderly patients with mild stroke afteRthrombolysis treatment.