急性脑卒中血管内治疗后无效再通的风险因素及其列线图预测模型构建

Risk factors and nomogram prediction model construction of ineffective recanalization after endovascular treatment in acute stroke

目的探讨急性脑卒中血管内治疗后无效再通的风险因素,并构建列线图预测模型,以期识别无效再通高风险的急性脑卒中患者。方法回顾性收集2018年1月至2020年6月南京医科大学附属南京医院/江苏省南京市第一医院收治的88例接受血管内治疗并达到完全再通(改良脑梗死溶栓分级2b~3级)的急性脑卒中患者的临床资料。根据3个月改良Rankin评分(mRS)分为有效再通组(mRS 0~2分,52例)和无效再通组(mRS 3~6分,36例)。比较两组患者一般资料、血常规及影像学资料,采用多因素logistic回归模型分析无效再通的独立相关因素,采用R语言软件基于独立相关因素构建急性脑卒中血管内治疗后无效再通列线图预测模型。结果无效再通组患者年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、弥散加权成像(DWI)梗死体积、低灌注强度比值(HIR)、系统免疫炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)均明显高于有效再通组,差异均有统计学意义(P<0.05)。年龄、入院时NIHSS评分、DWI梗死体积、HIR、SII、NLR、PLR是急性脑卒中血管内治疗后无效再通的独立相关因素,差异均有统计学意义(P<0.05)。基于上述独立相关因素构建列线图预测模型的一致性指数为0.907(95%可信区间:0.882~0.932,P<0.05)。结论年龄、入院时NIHSS评分、DWI梗死体积、HIR、SII、NLR、PLR是急性脑卒中血管内治疗后无效再通的危险因素,而基于上述危险因素构建的列线图预测模型对急性脑卒中血管内治疗后无效再通的发生具有一定的预测价值。

Objective To explore the risk factors of ineffective recanalization after endovascular treatment in acute stroke,and to construct the nomogram prediction model in order to identify the acute stroke patients with high risk of ineffective recanalization.Methods The clinical data of 88 patients with acute stroke receiving endovascular treatment and achieving complete recanalization(modified thrombolysis classification of cerebral infarction:grade 2b-3)in Affiliated Nanjing Hospital of nanjing Medical University and Nanjing Municipal First Hospital from January 2018 to June 2020 were collected retrospectively.The patients were divided into the effective recanalization[modified Rankin Score(mRS):0-2 points;n=52]and ineffective recanalization(mRS:3-6 points;n=36)according to the mRS score in 3 months.The general data,blood routine and imaging data were compared between the two groups.The multivariate logistic regression model was used to analyze the independent risk factors for ineffective recanalization.The nomogram model of ineffective recanalization after endovascular treatment in acute stroke based on these independent related factors were constructed by the R language software.Results The age,NIHSS score,diffusion weighted imaging(DWI)infarct volume,hypoperfusion intensity ratio(HIR),systemic immune inflammatory index(SII),neutrophil to lym-phocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)in the ineffective recanalization group were sig-nificantly higher than those in the effective recanalization group,and the differences were statistically signifi-cant(P<0.05).The age,NIHSS score at admission,DWI infarct volume,HIR,SII,NLR and PLR were the independent related factors of ineffective recanalization after endovascular treatment in acute stroke(P<0.05).The nomogram prediction model constructed based on the above independent risk factors had the con-sistency index of 0.907(95%CI:0.882-0.932,P<0.01).Conclusion Age,NIHSS score at admission,DWI infarct volume,HIR,SII,NLR and PLR are the risk factors of ineffective recanalization after endovascular treatment in acute stroke.The constructed nomogram model based on the above independent risk factors has a certain predictive value for ineffective recanalization occurrence after endovascular treatment in acute stroke.