列线图预测DWI阴性急性缺血性脑卒中的可行性研究

Feasibility Study of Nomogram in Predicting Diffusion Weighting Imaging Negative Acute Ischemic Stroke

目的 探讨列线图预测扩散加权成像(DWI)阴性急性缺血性脑卒中(AIS)的可行性。方法 回顾性搜集2020年1月至2022年12月进行重组组织纤溶酶原激活物(rt-PA)静脉溶栓治疗的AIS患者的临床及影像资料。将DWI阳性定义为A组(n=187)和DWI阴性为B组(n=49),单因素分析比较两组患者一般临床资料、影像学资料,将具有统计学差异的参数纳入二元Logistics回归分析,筛选预测DWI阴性AIS的独立危险因素并建立列线图模型。对所有预测DWI阴性的AIS独立危险因素与列线图预测模型进行受试者工作特征曲线(ROC)评价诊断效能。结果 A组患者血糖、溶栓前NIHSS评分大于B组(P<0.05),A组患者溶栓前ASPECTS评分小于B组(P<0.05),B组患者溶栓后90天预后明显优于A组患者(P<0.05)。二元Logistics回归方程结果显示溶栓前ASPECTS评分、溶栓前NIHSS评分、血糖为预测DWI阴性AIS的独立风险因素,建立列线图模型的ROC曲线下面积为0.828,取阈值为0.0056时,敏感性与特异性分别为90.4%、92.4%。校准曲线显示列线图预测DWI阴性AIS与实际发生率拟合度好。结论 DWI阴性的AIS患者进行静脉溶栓治疗预后明显优于DWI阳性的AIS患者,同时基于溶栓前ASPECTS评分、溶栓前NIHSS评分、血糖建立列线图模型能有效预测DWI阴性的AIS,为无法进行MRI检查的AIS患者提供静脉溶栓的临床参考证据。

Objective The aim of this study was to explore the feasibility of nomograms in predicting diffusion weighting imaging(DWI)negative acute ischemic stroke(AIS).Methods The clinical and radiological data of AIS patients who underwent recombinant tissue-type plasminogen activator(rt-PA)intravenous thrombolytic therapy in our hospital from January 2020 to December 2022 were retrospectively collected.DWI positivity was defined as group A(n=187)and DWI negative as group B(n=49),univariate analysis compared the general clinical data and radiological data of the two groups,and the parameters with statistical differences were included in the binary Logistics regression analysis,and the independent risk factors for predicting DWI-negative AIS were screened and a nomogram model was established.The diagnostic efficacy of the receiver operator characteristic curve(ROC)was evaluated by the independent risk factors of AIS and the nomogram prediction model for all predictions of DWI negative.Results The blood glucose and pre-thrombolytic national institute of health stroke scale(NIHSS)of patients in group A were greater than those in group B(P<0.05),the Alberta stroke program early CT Score(ASPECTS)before thrombolysis in group A were smaller than those in group B(P<0.05),and the 90-day prognosis of patients in group B was significantly better than that of patients in group A(P<0.05).The results of the binary Logistics regression equation showed that the ASPECTS before thrombolysis,the NIHSS before thrombolysis,and blood glucose were independent risk factors for predicting DWI-negative AIS,and the area under the ROC of the nomogram model was 0.828,and the threshold was 0.0056,the sensitivity and specificity were(90.4%and 92.4%).Conclusion The prognosis of intravenous thrombolytic therapy in patients with DWI-negative AIS is significantly better than that of patients with DWI-positive AIS,and the nomogram model based on pre-thrombolytic ASPECTS,pre-thrombolytic NIHSS and blood glucose can effectively predict DWI-negative AIS,and provide clinical evidence of intravenous thrombolysis for AIS patients who cannot undergo MRI examination.