老年急性脑梗死患者术后神经功能恢复不良的影响因素分析OACSTPCD
Analysis of the influencing factors for poor postoperative neurological function recovery in elderly patients with acute cerebral infarction
目的 分析老年急性脑梗死患者术后神经功能恢复不良的影响因素,并构建风险列线图预测模型.方法 选取2021-01-2022-12于发病4.5 h内在济宁医学院附属医院进行静脉溶栓术的174例老年急性脑梗死患者,根据术后神经功能恢复情况分为恢复良好组(n=113)与恢复不良组(n=61),采用Logistic回归分析影响老年急性脑梗死患者术后神经功能恢复的危险因素;采用R软件构建预测老年急性脑梗死患者术后神经功能恢复不良的列线图模型;采用ROC曲线、校准曲线、Hosmer-Lemeshow拟合优度检验评估列线图模型的效能.结果 174例老年急性脑梗死患者,61例(35.06%)术后神经功能恢复不良,113 例(64.94%)术后神经功能恢复良好.多因素Logistic回归分析显示,糖尿病(95%CI:2.466～21.685,P<0.001)、心房颤动(95%CI:1.485～24.484,P=0.012)、基线NIHSS评分≥12.50分(95%CI:5.945～53.525,P<0.001)、出血性转化(95%CI:1.823～15.328,P=0.002)、责任血管中度狭窄(95%CI:1.686～17.834,P=0.005)、责任血管重度狭窄(95%CI:2.769～40.737,P=0.001)为老年急性脑梗死患者术后神经功能恢复不良的独立危险因素.该列线图模型预测老年急性脑梗死患者术后神经功能恢复不良的ROC曲线下面积0.872(95%CI:0.816～0.928),绘制校准曲线显示预测概率曲线与实际概率曲线基本吻合,且Hosmer-Lemeshow拟合优度检验χ2=7.943,P=0.439.结论 糖尿病、心房颤动、基线NIHSS评分≥12.50分、出血性转化、责任血管中/重度狭窄是老年急性脑梗死患者术后神经功能恢复不良的独立危险因素,依此构建的风险列线图预测模型经验有较好的预测效能,能准确、有效预测老年急性脑梗死患者术后神经功能恢复不良发生风险.
Objective To analyze the influencing factors for poor postoperative neurological function recovery in elderly patients with acute cerebral infarction,and to construct a risk column chart prediction model.Methods A total of 174 elderly patients with acute cerebral infarction who underwent intravenous thrombolysis within 4.5 hours of onset in the Affilized Hospital of Jining Medical college from January 2021 to December 2022 were selected,according to the postoperative recovery of neurological function,they were grouped into good recovery group(n=113)and poor recovery group(n=61).Logistic regression analysis was applied to analyze the risk factors affecting postoperative neurological recovery in elderly patients with acute cerebral infarction.R software was applied to construct a column chart model for predicting poor postoperative neurological function recovery in elderly patients with acute cerebral infarction.ROC curve,calibration curve and Hosmer-Lemeshow goodness of fit test were applied to evaluate the efficacy of nomogram model.Results Among 174 elderly patients with acute cerebral infarction,61(35.06%)had poor postoperative neurological recovery,and 113(64.94%)had good postoperative neurological recovery.Multivariate Logistic regression analysis showed that there were diabetes(95%CI:2.466-21.685,P<0.001),atrial fibrillation(95%CI:1.485-24.484,P=0.012),baseline NIHSS score≥12.50(95%CI:5.945-53.525,P<0.001),hemorrhagic transformation(95%CI:1.823-15.328,P=0.002),moderate stenosis of responsible vessels(95%CI:1.686-17.834,P=0.005),and severe stenosis of the responsible vessels(95%CI:2.769-40.737,P=0.001)were independent risk factors for poor postoperative neurological recovery in elderly patients with acute cerebral infarction.The nomogram model predicted the area under the Receiver operating characteristic of poor postoperative neurological function recovery in elderly patients with acute cerebral infarction at 0.872(95%CI:0.816-0.928).The calibration curve drawn showed that the predicted probability curve was basically consistent with the actual probability curve,and Hosmer-Lemeshow goodness of fit test χ 2=7.943,P=0.439.Conclusion Diabetes,atrial fibrillation,baseline NIHSS score≥12.50,hemorrhagic transformation,and moderate/severe stenosis of responsible vessels are independent risk factors for poor neurological recovery in elderly patients with acute cerebral infarction after surgery.The risk column chart prediction model constructed based on this has been validated to have good predictive performance and can accurately and effectively predict the risk of poor postoperative neurological function recovery in elderly patients with acute cerebral infarction.
付秀芳;杨宪章;张晓娟;文娇;高君;陈运峰;张强
济宁医学院附属医院,山东 济宁 272067
临床医学
急性脑梗死老年神经功能恢复影响因素风险列线图预测模型
Acute cerebral infarctionElderlyNeurological function recoveryInfluencing factorsRisk column chart prediction model
《中国实用神经疾病杂志》 2024 (003)
301-306 / 6
山东省中医药科技发展计划项目(编号:2013ZDZK-092)
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