静脉溶栓治疗轻型缺血性脑卒中患者预后不良结局的影响因素及列线图模型的构建

Influencing factors for adverse outcomes in patients with mild ischemic stroke treated by intravenous thrombolysis and construction of a Nomogram model

目的探讨静脉溶栓治疗轻型缺血性脑卒中(MIS)患者预后不良结局的影响因素并构建列线图模型。方法选取2021-06—2023-06榆林市第一医院就诊的MIS患者191例,于治疗90 d后以改良Rankin量表(mRS)评估预后情况,通过单因素、LASSO回归模型、Logistic回归分析预后不良的影响因素,基于Logistic回归分析结果构建MIS患者预后不良的风险预测列线图模型,并对模型进行验证。结果静脉溶栓治疗90 d后MIS患者预后不良发生率为37.17%(71/191)。年龄(OR=7.971,95%CI:4.127~15.397)、发病至治疗时间(OR=1.600,95%CI:1.145~2.235)、高血压(OR=6.899,95%CI:5.114~9.306)、责任大动脉病变(OR=7.885,95%CI:7.201~8.634)、溶栓前血浆信号肽Cub-Egf结构域蛋白1(SCUBE1)水平(OR=1.498,95%CI:1.105~2.031)、溶栓前C反应蛋白(CRP)水平(OR=1.615,95%CI:1.121~2.327)、溶栓前基质细胞衍生因子-1(SDF-1)水平(OR=1.866,95%CI:1.312~2.653)是MIS患者预后不良的独立影响因素。预后不良列线图模型C-index为0.876(95%CI:0.849~0.963),ROC曲线下面积(AUC)为0.873(95%CI:0.824~0.923)。DCA曲线提示,当风险阈值在0.42~0.85时使用该模型具有较好的临床净获益。结论年龄、发病至治疗时间、高血压、责任大动脉病变及溶栓前SCUBE1、CRP、SDF-1水平是静脉溶栓治疗MIS患者预后不良的影响因素,基于上述危险因素构建的列线图模型具有良好的校准度、区分能力及临床实用性。

Objective To investigate the influencing factors for adverse outcomes in patients with mild ischemic stroke(MIS)treated by intravenous thrombolysis and establish a Nomogram model.Methods A total of 191 patients with MIS who were treated in the First Hospital of Yulin from June 2021 to June 2023 were selected.After 90 days of treatment,the prognosis was evaluated by the modified Rankin scale(mRS).The adverse prognostic factors were analyzed by univariate,LASSO regression model and Logistic regression.Based on the results of Logistic regression analysis,a Nomogram model was constructed to predict the risk of poor prognosis in MIS patients,and the model was verified.Results After 90 days of intravenous thrombolysis,the incidence of adverse prognosis in MIS patients was 37.17%(71/191).Age(OR=7.971,95%CI:4.127-15.397),time from onset to treatment(OR=1.600,95%CI:1.145-2.235),hypertension(OR=6.899,95%CI:5.114-9.306),major artery disease(OR=7.885,95%CI:7.201-8.634),the level of SCUBE1(OR=1.498,95%CI:1.105-2.031),the level of C-reactive protein(CRP)before thrombolysis(OR=1.615,95%CI:1.121-2.327)and pre-thrombolytic stromal cell derived factor-1(SDF-1)levels(OR=1.866,95%CI:1.312-2.653)were independent factors for poor prognosis in patients with MIS.The C-index of the poor prognosis model was 0.876(95%CI:0.849-0.963),and the area under the curve(AUC)was 0.873(95%CI:0.8247-0.923),the DCA curve suggested that the model had a good clinical net benefit when the risk threshold was 0.42-0.85.Conclusion Age,time from onset to treatment,hypertension,responsible major artery disease,SCUBE1,CRP and SDF-1 levels before thrombolytic therapy are the influencing factors for poor prognosis in patients with MIS.The column graph model constructed based on the above risk factors has good calibration,differentiation ability and clinical applicability.