基于视网膜中央动脉管径预测概率对急性缺血性脑卒中的风险评估方法

Risk assessment method for acute ischemic stroke based on the probability of predicting the diameter of the central retinal artery

目的建立一种基于视网膜中央动脉管径(CRAE)的预测概率评估患急性缺血性脑卒中风险的方法。方法回顾性收集2018年5月至2020年5月在首都医科大学附属北京友谊医院神经内科门诊和住院同时进行头颅磁共振成像、头颈部CT血管造影检查的268例患者的临床资料,其中121例确诊为急性缺血性脑卒中,将其作为脑卒中组,另外147例排除急性缺血性脑卒中的诊断,将其作为对照组。收集2组患者的基本资料(包括年龄、性别、身高、体重、卒中相关病史等),瞳孔扩张后进行眼底摄影,并使用半自动血管测量软件测量视网膜血管管径,计算CRAE、视网膜中央静脉管径(CRVE)和视网膜动静脉管径比值(AVR)。Logistic模型分析用于建立不同的急性缺血性卒中风险评估模型,通过受试者工作特征(ROC)曲线比较曲线下面积(AUC)评价模型的效果。结果2组患者的年龄、体重指数、高血压、CRVE和AVR比较,差异均无统计学意义(P>0.05)。脑卒中组男性、高脂血症、糖尿病、冠心病、吸烟、饮酒史的患者比率均高于对照组,CRAE低于对照组,差异均有统计学意义(P<0.05)。预测概率、年龄、高血压、高血脂、糖尿病、吸烟、饮酒、CRAE的AUC均大于0.5,预测概率值AUC为0.769,CRAE AUC为0.610,其中AUC从高到低依次为预测概率值、糖尿病、CRAE、吸烟、饮酒、高血压、高血脂、年龄。结论传统的缺血性脑卒中危险因素结合CRAE等效值和预测概率曲线有助于筛查急性缺血性卒中的高危人群。

Objective To establish a predictive probability based method for assessing the risk of acute ischemic stroke based on the diameter of the central retinal artery(CRAE).Methods From May 2018 to May 2020,268 patients who were diagnosed as acute ischemic stroke by clinical and imaging examinations were retrospectively collected from the outpatient and inpatient of the Departments of Neurology,Beijing Friendship Hospital,Capital Medical University.Among them,121 patients were diagnosed with acute ischemic stroke,which were regarded as the stroke group,and 147 patients were excluded from the diagnosis of acute ischemic stroke,which was regarded as the control group.Basic data(including age,gender,height,weight,stroke related medical history,etc)of the patients in the two groups were collected,fundus photography was performed after pupil dilation,and diameter of retinal blood vessels was measured using semi-automatic vascular measurement software,and CRAE,central retinal vein equivalent(CRVE),and retinal arteriovenous equivalent ratio(AVR)were calculated.Logistic model analysis was used to establish different models of ischemic stroke risk assessment,and the effect of the model was evaluated by comparing the area under the curve(AUC)with the receiver operating characteristic(ROC).Results There was no statistically significant difference in age,body mass index,hypertension,CRVE,and AVR between the two groups of patients(P>0.05).The ratio of male,hyperlipidemia,diabetes,coronary heart disease,smoking and drinking history patients in the stroke group were higher than those in the control group,and CRAE was lower than that in the control group,the differences were statistically significant(P<0.05).The AUC of prediction probability,age,hypertension,hyperlipidemia,diabetes,smoking,drinking,and CRAE were all greater than 0.5.The prediction probability value AUC was 0.769,and the CRAE AUC was 0.610.The AUC from high to low were the predictive probability value,diabetes,CRAE,smoking,drinking,hypertension,hyperlipidemia,and age.Conclusion Traditional risk factors for ischemic stroke,combined with the equivalent value of central retinal artery diameter(CRAE)and predicted probability curve,which are helpful in screening high-risk populations for acute ischemic stroke.