急性缺血性脑卒中静脉溶栓后血管再闭塞预测模型构建及评价

Construction and evaluation the prediction model of vascular reocclusion after intravenous thrombolysis in acute ischemic stroke

目的建立急性缺血性脑卒中(AIS)静脉溶栓治疗后血管再闭塞的列线图预测模型,并进行初步验证。方法回顾性分析2020年1月—2023年6月在湖南中医药大学第一附属医院接受静脉溶栓治疗的316例AIS患者的临床资料,根据静脉溶栓后血管再闭塞情况分为无闭塞组(264例)和再闭塞组(52例)。比较2组临床特征差异,采用多因素logistic回归分析研究血管再闭塞的影响因素并建立列线图模型,采用ROC曲线和校准曲线评估模型的区分度和校准度,同时进行临床决策曲线分析。结果经单因素分析和多因素logistic回归分析显示,有房颤史、基线美国国立卫生研究院卒中量表(NIHSS)评分高、发病到治疗时间延长是AIS患者静脉溶栓治疗后血管再闭塞的危险因素,而应用替罗非班则是保护因素(P<0.05)。构建的列线图模型的ROC曲线下面积(95%CI)为0.768(0.701~0.835)。校准曲线显示,模型预测血管再闭塞的预测和实际发生概率有较好的一致性(Hosmer-Lemeshowχ^(2)=8.246,P=0.410),当利用本模型预测AIS患者溶栓后血管再闭塞风险>0.15时,采取相应的干预措施,可使患者有较好的临床获益。结论AIS患者静脉溶栓治疗后血管再闭塞的影响因素较多,合理构建的列线图模型具有较好的区分度和准确度,可用于患者的风险分层。

Objective To establish and validate a nomogram prediction model for vessel re-occlusion after intravenous thrombolysis in acute ischaemic stroke(AIS).Methods A total of 316 patients with AIS who received intravenous thrombolysis at the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2020 to June 2023 were retrospectively analyzed,and divided into non-occlusion group(264 cases)and re-occlusion group(52 cases)according to the status of re-occlusion after intravenous thrombolysis.The differences in clinical characteristics between the two groups were compared,factors affecting vessel re-occlusion were analyzed by multivariate logistic regression and a nomogram model was created.The degree of discrimination and calibration of the model was assessed by using receiver operating characteristic(ROC)and calibration curves,and the clinical decision curve was analyzed.Results Univariate and multivariate logistic regression analysis showed that history of atrial fibrillation,high baseline National Institutes of Health Stroke Scale(NIHSS)score and longer time from onset to treatment were risk factors for re-occlusion after intravenous thrombolysis in AIS patients,whereas Tirofiban was protective factor(P<0.05).The area under ROC curve(AUC)of the constructed nomogram model was 0.768(0.701-0.835).The calibration curve showed that there was good agreement between the prediction of vessel reocclusion by the model and the actual probability of occurrence(Hosmer-Lemeshowχ^(2)=8.246,P=0.410).If the risk of vessel re-occlusion after thrombolysis in AIS patients is predicted to be>0.15 using this model,appropriate interventional measures should be taken.It can make patients get better clinical benefit.Conclusion There are many factors that influence vessel re-occlusion after intravenous thrombolytic therapy in AIS patients,and the reasonably constructed column diagram model has good discriminatory power and accuracy,which can be used for risk stratification of patients.