2型糖尿病合并急性脑梗死患者溶栓后短期预后列线图模型构建

Construction of short-term prognostic nomogram model for type 2 diabetes patients with acute ischemic stroke after thrombolysis

目的分析2型糖尿病(T2DM)合并急性脑梗死(AIS)患者溶栓后24小时短期预后恶化的影响因素,并在此基础上建立列线图预测模型。方法选取2019年1月至2023年5月于山东大学齐鲁医院住院的283例急性脑梗死患者,采用多因素Logistic回归分析2型糖尿病合并急性脑梗死溶栓后短期预后的影响因素,在此基础上建立列线图模型,采用ROC曲线、校准曲线、决策曲线以及临床影响曲线验证模型的预测能力。结果T2DM+AIS组血糖高于AIS组,短期预后较AIS组差(P<0.05)。多因素Logistic回归分析结果显示,HbA1c、Hcy水平是T2DM+AIS患者短期预后恶化的危险因素。短期预后恶化与HbA1c、Hcy呈显著正相关。HbA1c、Hcy分别预测短期预后恶化的ROC曲线下面积为0.808、0.804,最佳截断值为7.55%、15.55μmol/L,敏感度为88.0%、58.0%,特异度为60.0%、96.2%。构建的列线图ROC曲线下面积为0.879,敏感度82.0%,特异度86.2%。结论HbA1c和Hcy是T2DM合并AIS患者溶栓后的危险因素并可预测溶栓后24小时短期预后,所构建的列线图模型具有较好的预测评估价值,可为临床高危人群的筛选提供一定的参考。

Objective To analyze the influencing factors of short-term prognosis deterioration within 24 hours after thrombolysis in patients with type 2 diabetes mellitus(T2DM)and acute ischemic stroke(AIS),and establish a nomogram prediction model on this basis.Methods A total of 283 patients with AIS admitted to our hospital from January 2019 to May 2023 were selected.Multivariate logistic regression analysis was used to analyze the factors affecting the short-term prognosis of T2DM patients with AIS after thrombolysis.On this basis,a nomogram model was established.ROC curve,calibration curve,decision curve and clinical impact curve were used to verify the predictive ability of the model.Results The blood glucose levels in the T2DM+AIS group were higher than those in the AIS group,and the short-term prognosis of the T2DM+AIS group was worse than that of the AIS group(P<0.05).The results of multivariate binary logistic regression analysis showed that glycosylated hemoglobin(HbA1c)and homocysteine(Hcy)were risk factors for short-term deterioration of prognosis in T2DM+AIS patients.The short-term prognosis deterioration is significantly positively correlated with HbA1c and Hcy.The area under the ROC curves for HbA1c and Hcy predicting the short-term prognosis deterioration was 0.808 and 0.804,respectively.The optimal cutoff values are 7.55%and 15.55μmol/L.The sensitivity was 88.0%and 58.0%.The specificity was 60.0%and 96.2%.The area under the ROC curves of the constructed nomogram was 0.879,with a sensitivity of 82.0%and a specificity of 86.2%.Conclusions HbA1c and Hcy are risk factors for T2DM patients with AIS after thrombolysis.The two indicators can predict short-term prognosis within 24 hours after thrombolysis.The constructed nomogram model has a good predictive evaluation value.It can provide a certain reference for screening high-risk populations in clinical practice.