中风与神经疾病杂志2025，Vol.42Issue(4)：321-327,7.DOI:10.19845/j.cnki.zfysjjbzz.2025.0064
轻型急性缺血性脑卒中早期神经功能恶化临床预测模型构建与验证
Construction and validation of a clinical predictive model for early neurological deterioration in patients with mild acute ischemic stroke
摘要
Abstract
Objective To investigate the risk factors for early neurological deterioration in mild acute ischemic stroke,to construct a clinical predictive model,and to perform internal validation of this model.Methods A retrospective analysis was performed for 739 patients with mild acute ischemic stroke who were admitted to Department of Neurology,Kuntong Hospital of Zunhua,from October 2020 to December 2023,and they were randomly divided into a training set with 534 patients(72.3%)and a validation set with 205 patients(27.7%)at a ratio of 7∶3.Univariate and multivariate logistic regression analyses were performed for the training set to determine the risk factors for early neurological deterioration in mild acute ischemic stroke.A clinical predictive model was constructed,and internal validation was performed in terms of discriminatory ability,calibration,and clinical decision making.A nomogram was plotted.Results The multivariate logistic regression analysis showed that female sex(OR=1.87,95%CI 1.14～3.09,P=0.014),time window≤6 hours(OR=3.10,95%CI 1.56～6.19,P=0.001),a baseline NIHSS score of 2 points(OR=3.72,95%CI 1.30～10.61,P=0.014),a baseline NIHSS score of 3 points(OR=4.24,95%CI 1.45～12.35,P=0.008),a TOAST classification of large artery atherosclerosis(OR=3.88,95%CI 2.20～6.83,P<0.001),and the responsible arteries of the basilar artery,the middle cerebral artery,and the internal carotid artery(OR=8.39,95%CI 2.28～30.85,P=0.001;OR=6.22,95%CI 1.78～21.71,P=0.004;OR=5.38,95%CI 1.15～25.13,P=0.032)were independent risk factors for early neurological deterioration in mild acute ischemic stroke.The clinical predictive model constructed showed a moderate discriminatory ability(AUC>0.7),good calibration(P>0.05)in the Hosmer-Lemeshow goodness-of-fit test),and good clinical benefits in both the training set and the validation set.Conclusion This clinical predictive model can effectively predict the onset of early neurological deterioration in mild acute ischemic stroke and guide clinicians to make decisions,and therefore,it holds promise for clinical application.关键词
急性缺血性脑卒中/轻型卒中/早期神经功能恶化/诺莫图Key words
Acute ischemic stroke/Mild acute ischemic stroke/Early neurological deterioration/Nomogram分类
临床医学引用本文复制引用
李卫来,吴伟红,纪颖..轻型急性缺血性脑卒中早期神经功能恶化临床预测模型构建与验证[J].中风与神经疾病杂志,2025,42(4):321-327,7.基金项目
河北省卫生厅指导性课题项目(20160724) （20160724）
