目的 构建高龄急性脑梗死患者机械取栓治疗近期预后的列线图模型,并评价该模型的准确性以及临床适用性。方法 回顾性分析三个高级卒中中心行机械取栓治疗的高龄急性脑梗死患者的临床资料,根据90天后改良Rankin量表评分将其分为预后良好组以及预后不良组,采用Logistic分析导致高龄急性脑梗死患者机械取栓治疗后近期预后不良的独立危险因素,基于上述独立危险因素利用R语言构建列线图模型,利用ROC曲线、Bootstrap方法以及临床决策曲线验证该模型的准确性和临床决策的获益性。结果 导致高龄急性脑梗死患者机械取栓治疗后近期预后不良的独立危险因素为：入院时NIHSS评分,合并糖尿病,股动脉穿刺到血管再通时间（PTR）,术后合并肺部感染,术后发生症状性脑出血,侧枝循环差。ROC曲线验证列线图模型显示：构建的列线图模型预测高龄急性脑梗死患者机械取栓治疗近期预后的预测能力较强（AUC=0.876,95%CI：0.71~0.94）,Bootstrap方法显示校准曲线的平均绝对误差为0.015,说明校准曲线与理想曲线贴合良好。临床决策曲线显示,列线图模型预测高龄急性脑梗死患者机械取栓治疗近期预后的发生阈值为0.04~0.95之间时该模型图的适用性最佳。结论 构建的列线图模型预测准确性高,具有较广泛的临床适用性。
Abstract
Objective To construct a nomogram model for the short-term prognosis of elderly patients with acute cerebral infarction treated with mechanical thrombectomy, and to evaluate the accuracy and clinical applicability of the model. Methods The clinical data of elderly patients with acute cerebral infarction who underwent mechanical thrombectomy in three high-end stroke centers were retrospectively analyzed. They were divided into good prognosis group and poor prognosis group according to the mRS score after 90 days. Logistics analysis was used to analyze the causes of acute cerebral infarction in the elderly. Independent risk factors for patients’ short-term poor prognosis after mechanical thrombectomy. Based on the above independent risk factors, a nomogram model was constructed using R language. The ROC curve, Bootstrap method and clinical decision curve were used to verify the accuracy of the model and the benefits of clinical decision-making. Results The independent risk factors for poor short-term prognosis in elderly patients with acute cerebral infarction after mechanical thrombectomy are: NIHSS score on admission, diabetes mellitus, femoral artery puncture to recanalization time (PTR), postoperative pulmonary infection, postoperative complications Later, symptomatic cerebral hemorrhage occurred and collateral circulation was poor. The ROC curve validation nomogram model shows that the constructed nomogram model has strong predictive ability to predict the short-term prognosis of elderly patients with acute cerebral infarction treated with mechanical thrombectomy (AUC=0.876, 95%CI 0.71-0.94). The Bootstrap method shows the calibration curve. The average absolute error is 0.015, indicating that the calibration curve fits well with the ideal curve. The clinical decision curve shows that the nomogram model has the best applicability when the incidence threshold for predicting the short-term prognosis of elderly patients with acute cerebral infarction after mechanical thrombectomy is between 0.04 and 0.95. Conclusion The constructed nomogram model has high prediction accuracy and has wide clinical applicability.
关键词
高龄 /
急性脑梗死 /
机械取栓 /
列线图模型 /
预后
Key words
advanced age /
acute cerebral infarction /
mechanical thrombectomy /
nomogram model /
prognosis
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基金
辽宁省自然科学基金“趋化因子及受体CCL11/CCR3调节脑梗死后神经发生的机制研究”（2019-645）; 辽宁省博士科研启动基金“miR-137和CACNA1C作为靶基因预测阿尔茨海默病的研究”（2019-221）; 本溪市科技局重点研发项目“不同机器学习模型预测急性缺血性脑卒中患者rt-PA溶栓后发生早期神经功能恶化的准确性比较”（2023ZDJH005）
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