脑卒中后吞咽功能障碍风险列线图模型的构建及效果评价

Establishment of risk nomogram model of swallowing dysfunction after stroke and its effect evaluation

目的构建并初步评价基于多维度指标的脑卒中后吞咽功能障碍风险列线图模型。方法选取2020年4月至2022年12月浙江大学医学院附属第二医院临平院区收治的132例脑卒中患者为研究对象,根据吞咽功能评估结果将患者分为吞咽功能障碍组(n=48)和吞咽功能正常组(n=84),筛选影响脑卒中后吞咽功能障碍的危险因素并构建脑卒中后吞咽功能障碍列线图风险模型。结果脑卒中后吞咽功能障碍发生率为36.36%(48/132)。吞咽功能障碍组患者的年龄≥60岁比例、高血压比例、病灶位于脑干比例、多发病灶比例、肌力≤3级比例、同型半胱氨酸水平均显著高于吞咽功能正常组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、高血压、病灶位于脑干、多发病灶、肌力≤3级均是影响脑卒中后吞咽功能障碍的危险因素(P<0.05)。基于上述危险因素建立脑卒中后吞咽功能障碍列线图风险模型,结果显示该模型预测性能良好,曲线下面积为0.897(95%CI:0.727~0.941)。结论年龄、高血压、病灶位于脑干、多发病灶、肌力分级均是影响脑卒中后吞咽功能障碍的独立危险因素,基于上述危险因素构建的脑卒中后吞咽功能障碍风险列线图模型预测效能较好,可作为筛查脑卒中后吞咽功能障碍的评估工具。

Objective To construct and initially evaluate the risk nomogram model of swallowing dysfunction after stroke based on multidimensional indicators.Methods A total of 132 stroke patients admitted to Linping District,the Second Affiliated Hospital,Zhejiang University School of Medicine from April 2020 to December 2022 were selected as the study objects.According to the results of swallowing function evaluation,the patients were divided into swallowing dysfunction group(n=48)and normal swallowing function group(n=84).The risk factors of swallowing dysfunction after stroke were screened and the risk model of swallowing dysfunction after stroke was constructed.Results The incidence of swallowing dysfunction after stroke was about 36.36%(48/132).The proportion of age≥60 years old,the proportion of hypertension,the proportion of lesions located in brain stem,the proportion of multiple lesions,the proportion of muscle strength≤grade 3 and the level of homocysteine in swallowing dysfunction group were significantly higher than those in normal swallowing function group(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years old,hypertension,lesions located in brain stem,multiple lesions,and muscle strength≤grade 3 were all risk factors for swallowing dysfunction after stroke(P<0.05).Based on the above risk factors,the risk model of swallowing dysfunction after stroke was established.The results showed that the model had good predictive performance,and the area under the curve was 0.897(95%CI:0.727~0.941).Conclusion Age,hypertension,location of lesions in brain stem,multiple lesions,and muscle strength grade are all independent risk factors for swallowing dysfunction after stroke.The risk nomogram model constructed based on the above risk factors has good predictive efficacy,and can be used as an assessment tool for screening swallowing dysfunction after stroke.