急性缺血性脑卒中后认知功能障碍风险预测模型构建与评估

Construction and evaluation of the risk prediction modelof cognitive dysfunction after acute ischemic stroke

目的:构建急性缺血性脑卒中病人认知功能障碍(post-stroke cognitive impairment,PSCI)的预测模型,以期有效识别PSCI发生的高风险人群,降低发病风险。方法:选择蚌埠医科大学第一附属医院2023年3-11月收治的143例新发急性缺血性脑卒中病人。于治疗后随访3~6个月,根据病人MMSE评分将其分为认知障碍组和认知正常组,通过logistic回归分析构建预测模型,分析PSCI的影响因素,并使用ROC分析对模型效能进行评价。结果:logistic回归分析显示,有冠心病史、NIHSS评分高、入院时mRS评分高、D-二聚体水平高是急性缺血性脑卒中病人认知功能障碍的危险因素,差异均有统计学意义(P<0.05~P<0.01)。ROC分析显示,NIHSS、D-二聚体、mRS评分、冠心病史以及上述四个指标联合预测急性缺血性脑卒中病人认知功能障碍的曲线下面积分别为0.728、0.641、0.700、0.583、0.733。结论:通过logistic回归分析构建PSCI预测模型,NIHSS、D-二聚体、冠心病史和入院时mRS可能是急性缺血性脑卒中病人发生PSCI的独立危险因素,对PSCI具有一定的预测能力且联合预测的效能更佳。

Objective:To establish a prediction model of post-stroke cognitive impairment(PSCI)in patients with acute ischemic stroke,in order to effectively identify the high-risk group of PSCI and reduce the risk of PSCI.Methods:A total of 143 new acute ischemic stroke patients admitted to The First Affiliated Hospital of Bengbu Medical University from March to November 2023 were selected.After 3-6 months of follow-up,patients were divided into the cognitive impairment group and cognitive normal group according to MMSE score.The predictive model was constructed by logistic regression analysis,the influencing factors of PSCI were analyzed,and the effectiveness of model was evaluated by ROC analysis.Results:The results of logistic regression analysis showed that history of coronary heart disease,high NIHSS score,high mRS score on admission,D-dimer levels were the risk factors of cognitive dysfunction in patients with acute ischemic stroke,and the differences of which were statistically significant(P<0.05 to P<0.01).The results of ROC analysis,the areas under the curve of NIHSS,D-dimer,mRS,history of coronary heart disease and combined predicted cognitive dysfunction in patients with acute ischemic stroke were 0.728,0.641,0.700,0.583 and 0.733,respectively.Conclusions:The prediction model of PSCI is constructed by logistic regression analysis.The NIHSS,D-dimer,history of coronary heart disease and mRS on admission may be the independent risk factors of PSCI in patients with acute ischemic stroke.They have certain prediction ability for PSCI,and the combined prediction efficiency is better.