基于LASSO回归的以急性脑梗死为表现的Trousseau综合征预后影响因素分析

Analysis of prognostic factors in Trousseau syndrome with acute cerebral infarction based on LASSO regression

目的利用最小绝对值收敛和选择算子(LASSO)回归分析以急性脑梗死为表现的Trousseau综合征患者预后的影响因素。方法选取以急性脑梗死为表现的Trousseau综合征患者49例,根据脑梗死后90 d改良Rankin量表(mRS)评分将患者分为预后良好组(<3分,17例)及预后不良组(≥3分,32例)。比较2组患者一般临床资料、入院时影像学资料、实验室检查结果及预后情况差异。使用LASSO回归筛选影响预后的变量,构建模型,通过受试者工作特征(ROC)曲线及H-L拟合优度检验评价模型的预测价值。结果所有患者中,病理类型为腺癌39例。与预后良好组相比,预后不良组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分较高、确诊肿瘤时间距脑梗死发生时间<6个月患者占比及肿瘤转移患者占比高,血红蛋白(Hb)水平及单抗凝治疗患者占比低(P<0.05)。LASSO回归显示,Hb水平和单抗凝治疗与患者预后呈正相关,入院时NIHSS评分与患者预后呈负相关。ROC曲线显示,LASSO回归模型预测曲线下面积为0.871(95%CI:0.766~0.976),敏感度为0.875,特异度为0.706,H-L拟合优度检验P=0.978。结论在以急性脑梗死表现的Trousseau综合征患者中,Hb水平和单抗凝治疗与患者预后呈正相关,入院时NIHSS评分与患者预后呈负相关。

Objective To analyze the prognostic factors of Trousseau syndrome with acute cerebral infarction using the least absolute shrinkage and selection operator(LASSO)regression.Methods with acute cerebral infarction were selected in this study.Patients were divided into the good prognosis group(<3 points,n=17)and the poor prognosis group(≥3 points,n=32)according to the modified Rankin Scale(mRS)score 90 days after discharge.The general clinical data,imaging data on admission,laboratory examination results and prognosis were compared between the two groups.LASSO regression was used to screen variables related to prognosis,and the model was constructed.The predictive value of the model was evaluated by receiver operating characteristic(ROC)curve and H-L goodness of fit test.Results prognosis group,there were higher National Institutes of Health Stroke Scale(NIHSS)score at admission,higher proportion of patients diagnosed with tumor less than 6 months after cerebral infarction,lower hemoglobin(Hb)level,and lower proportion of patients treated with monoclonal anticoagulation in the poor prognosis group(P<0.05).LASSO regression analysis showed that Hb level and monoclonal anticoagulation therapy were positively correlated with prognosis,and NIHSS score at admission was inversely correlated with prognosis.The AUC of the LASSO regression model was 0.871(95%CI:0.766-0.976),sensitivity was 0.875 and the specificity was 0.706.H-L goodness of fit test P=0.978.Conclusion Trousseau syndrome patients with acute cerebral infarction,Hb level and monoclonal anticoagulation therapy were positively correlated with prognosis,and NIHSS score at admission was inversely correlated with prognosis.