基于脑小血管病影像总负荷(CSVD)的急性脑梗死静脉溶栓患者预后列线图预测模型建立

Establishment of nomogram prediction model for prognosis of acute cerebral infarction patients treated with intravenous thrombolysis based on total cerebral small vessel disease burden scores(CSVD)

目的探讨将脑小血管影像负荷(CSVD)纳入急性脑梗死(ACI)静脉溶栓患者预后列线图预测模型,并分析该模型的预测效能。方法回顾性分析2019年11月—2020年1月在邢台市人民医院经静脉溶栓治疗的急性脑梗死患者286例,根据治疗后90 d改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分<3分,n=155)与预后不良组(mRS评分≥3分,n=131)。多因素Logistic回归分析影响ACI预后相关因素,以此构建列线图模型并验证其预测效果。结果两组患者在年龄、发病前mRS评分、吞咽功能评分、发病至溶栓时间、入院到溶栓时间、溶栓前NIHSS评分、溶栓后即刻NIHSS评分、合并高血压、胆固醇、低密度脂蛋白、Hcy、吸烟指数、总CSVD评分等方面存在显著差异(P<0.05);多因素Logistic回归分析显示,年龄、发病前mRS评分、吞咽功能评分、溶栓后即刻NIHSS评分、合并高血压、胆固醇、低密度脂蛋白、Hcy、吸烟指数、总CSVD评分(OR=3.117,95%CI=1.925~11.170)是影响ACI患者预后不良的高危因素(P<0.05);将多因素筛选出的高危因素构建列线图模型,其中校准曲线与理想曲线贴合良好,ROC曲线显示C-in-dex指数为0.794(0.710~0.879),该模型具有良好的精准度和区分度。结论总CSVD评分是影响ACI患者静脉溶栓后预后的独立因素,且以此建立的列线图模型对ACI预后具有较好的预测能力。

Objective To establish a nomogram prediction model for the prognosis of acute cerebral infarction(ACI)patients treated with intravenous thrombolysis based on total cerebral small vessel disease(CSVD)burden scores,and to assess the predictive efficacy of the model.Methods A retrospectively analysis was conducted on 286 ACI patients treated with intravenous thrombolysis at Xingtai People’s Hospital from November 2019 to January 2020.The 90-day clinical outcome was assessed using the modified Rankin Scale(mRS).Patients were divided into a good prognosis group(mRS score<3,n=155)and a poor prognosis group(mRS score≥3,n=131)according to mRS score.Multivariate Logistic regression analysis was conducted to identify the related factors affecting the prognosis of ACI,and a nomogram model was constructed based on the above factors and validated for its predictive performance.Results A statistical difference was demonstrated between two groups in terms of age,premorbid mRS score,swallowing function score,onset-to-door time,door-to-needle time,pre-thrombolysis National Institute of Health Stroke Scale(NIHSS)score,immediate post-thrombolysis NIHSS score,comorbid hypertension,total cholesterol,low-density lipoprotein cholesterol,homocysteine(Hcy),smoking index,and total CSVD score(all P<0.05).Multivariate logistic regression analysis showed that age,premorbid mRS score,swallowing function score,immediate post-thrombolysis NIHSS score,comorbid hypertension,total cholesterol,low-density lipoprotein cholesterol,Hcy,smoking index and total CSVD score(OR=3.117,95%CI=1.925~11.170)were high risk factors for poor prognosis in ACI patients(P<0.05).A nomogram model was constructed based on the high-risk factors identified by multivariate screening,and the calibration curve fitted well with the ideal curve.The receiver operating characteristic(ROC)curve indicated that the concordance index(C-index)of 0.758(0.724-0.792),suggesting that the model had good predictive accuracy and discriminative ability.Conclusion The total CSVD score is an independent factor influencing the prognosis after intravenous thrombolysis in ACI patients,and the established nomogram model has good predictive efficacy for the prognosis of ACI.