摘要
目的建立和验证预测急性缺血性卒中取栓后无效再通的动态网页列线图。方法回顾性分析2017年5月至2021年4月于苏州大学附属第二医院神经内科接受取栓术且获得成功再灌注的急性缺血性卒中304例患者的临床资料,按照7∶3的比例将全部患者以简单随机抽样法分为建模组(n=216)和验证组(n=88)。以建模组的数据建立列线图并进行内部验证,以验证组的数据进行外部验证。对于建模组,通过纳入在单因素分析中所有P<0.05的变量进行多因素Logistic回归分析,筛选出无效再通的独立预测因子后构建列线图。在建模组与验证组中分别通过C指数、校准图和决策曲线分析来验证列线图性能。结果建模组和验证组间未检测到无效再通率差异有统计学意义[134/216(62.0%)和56/88(63.6%),χ2=0.07,P=0.794]。多因素Logistic回归分析结果显示年龄(OR=1.04,95%CI 1.00~1.08,P=0.033)、入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.11,95%CI 1.04~1.19,P=0.001)、中性粒细胞/淋巴细胞比值(OR=1.19,95%CI 1.07~1.32,P=0.001)、糖化血红蛋白(OR=2.02,95%CI 1.34~3.05,P<0.001)、较差侧支循环(OR=10.87,95%CI 4.08~29.01,P<0.001)、术后高密度征(OR=11.38,95%CI 4.56~28.40,P<0.001)为无效再通的独立危险因素。建模组与验证组列线图模型的C指数分别为0.92(95%CI 0.88~0.95,P<0.001)和0.93(95%CI 0.87~0.98,P<0.001)。结论由年龄、入院时NIHSS评分、中性粒细胞/淋巴细胞比值、糖化血红蛋白、较差侧支循环、术后高密度征构建的网页列线图能够便捷、精准与可靠地预测急性缺血性卒中患者接受机械取栓术后发生无效再通的概率。
Objective To establish and verify a dynamic web-based nomogram for predicting futile recanalization after thrombectomy in acute ischemic stroke.Methods Three hundred and four acute ischemic stroke patients admitted to the Second Affiliated Hospital of Soochow University from May 2017 to April 2021 were retrospectively enrolled.All these patients underwent mechanical thrombectomy and obtained successful recanalization.The eligible patients were randomly divided into training group(n=216)and test group(n=88)by 7∶3.The nomogram was established and internally validated with the data of the training group,and externally validated with the data of the test group.For the training group,multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis,and the independent predictors of futile recanalization were screened out to construct a nomogram.In the training group and the test group,the performance of the nomogram was verified by C-index,calibration chart and decision curve analysis respectively.Results No significant difference was detected between the training group and the test group in futile recanalization[134/216(62.0%)vs 56/88(63.6%),χ2=0.07,P=0.794].Multivariate Logistic regression analysis showed that age(OR=1.04,95%CI 1.00-1.08,P=0.033),National Institutes of Health Stroke Scale(NIHSS)score on admission(OR=1.11,95%CI 1.04-1.19,P=0.001),neutrophil to lymphocyte ratio(OR=1.19,95%CI 1.07-1.32,P=0.001),glycated hemoglobins(OR=2.02,95%CI 1.34-3.05,P<0.001),poor collateral status(OR=10.87,95%CI 4.08-29.01,P<0.001),postoperative high density(OR=11.38,95%CI 4.56-28.40,P<0.001)were independent risk factors for futile recanalization.The C-index of this nomogram in the training group and the test group was 0.92(95%CI 0.877-0.954,P<0.001)and 0.93(95%CI 0.87-0.98,P<0.001),respectively.Conclusion This web-based nomogram,including age,NIHSS score on admission,neutrophil to lymphocyte ratio,glycated hemoglobin,poor collateral status and postoperative high density,predicted individual probability of futile recanalization after mechanical thrombectomy with good discrimination and clinical utility.
作者
俞帅
姜倩梅
郭志良
尤寿江
黄志超
侯杰
王怀舜
肖国栋
Yu Shuai;Jiang Qianmei;Guo Zhiliang;You Shoujiang;Huang Zhichao;Hou Jie;Wang Huaishun;Xiao Guodong(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2022年第10期1118-1127,共10页
Chinese Journal of Neurology
基金
苏州市科技局医工结合项目(SLJ2021014)
国家自然科学基金青年项目(81801154)。
关键词
急性病
卒中
脑缺血
无效再通
动态列线图
预测模型
Acute disease
Stroke
Brain ischemia
Futile recanalization
Dynamic nomogram
Prediction model
