摘要
目的探讨超氧化物歧化酶(superoxide dismutase,SOD)与血清淀粉样蛋白A(serum amyloid A,SAA)对腔隙性脑梗死患者短期不良预后的预测价值。方法回顾性分析2021年1月1日-12月31日在皖南医学院第二附属医院诊治的185例腔隙性脑梗死患者的临床资料,根据出院后3个月改良Rankin量表(modified Rankin Scale,mRS)评分将患者分为预后良好组(mRS≤2分)及预后不良组(mRS>2分),采用多因素logistic回归分析腔隙性脑梗死患者短期不良预后的独立危险因素并构建风险预测模型(诺莫图),采用受试者操作特征曲线分析SOD、SAA及诺莫图对不良预后的预测效能,采用校准曲线及决策曲线分析评估模型的区分度及临床应用价值。结果研究纳入185例腔隙性脑梗死患者,平均年龄(68.26±10.77)岁,其中男性80例(43.2%),出现不良预后者39例(21.1%)。多因素logistic回归分析提示,收缩压[比值比(odds ratio,OR)=1.028,95%置信区间(confidence interval,CI)(1.004,1.052),P=0.021]、糖尿病[OR=4.939,95%CI(1.703,14.320),P=0.003]、SAA[OR=1.089,95%CI(1.052,1.128),P<0.001]、载脂蛋白B[OR=7.647,95%CI(2.186,26.753),P=0.001]是腔隙性脑梗死患者不良预后的独立危险因素,SOD[OR=0.979,95%CI(0.965,0.994),P=0.006]是保护性因素。基于上述因素构建的诺莫图预测腔隙性脑梗死短期不良预后的曲线下面积为0.874[95%CI(0.812,0.936),P<0.001],校准曲线对诺莫图进行拟合优度检测提示预测概率与实际发生概率较为一致(Hosmer-Lemeshow检验P=0.295),决策曲线提示诺莫图有较好的临床应用价值。结论SAA和SOD对腔隙性脑梗死患者短期不良预后有较好的预测价值,基于其构建的诺莫图具有较好的区分度及一致性,可为临床医师评估腔隙性脑梗死患者预后提供依据。
Objective To explore the predictive value of superoxide dismutase(SOD)and serum amyloid A(SAA)in short-term poor prognosis in patients with lacunar infarction.Methods The clinical data of 185 patients who were diagnosed with lacunar infarction in the Second Affiliated Hospital of Wannan Medical College between January 1st and December 31st,2021 were analyzed retrospectively.According to the modified Rankin Scale(mRS)score 3 months after discharge,the patients were divided into the good prognostic group(mRS≤2)and the poor prognostic group(mRS>2).Multiple logistic regression was used to analyze the independent risk factors of the short-term adverse prognosis of patients with lacunar infarction,and a risk prediction model(nomograph)was constructed.The predictive efficacy of SOD,SAA and nomograph for poor prognosis was analyzed by using the receiver operating characteristic curve.Calibration curve and decision curve analysis were used to evaluate the differentiation and clinical application value of the model.Results A total of 185 lacunar cerebral infarction patients with a mean age of(68.26±10.77)years were enrolled in this study,among whom 80(43.2%)were males and 39(21.1%)had adverse prognosis.Multiple logistic regression analysis showed that systolic blood pressure[odds ratio(OR)=1.028,95%confidence interval(CI)(1.004,1.052),P=0.021],diabetes[OR=4.939,95%CI(1.703,14.320),P=0.003],SAA[OR=1.089,95%CI(1.052,1.128),P<0.001],apolipoprotein B[OR=7.647,95%CI(2.186,26.753),P=0.001]were independent risk factors for poor prognosis in lacunar infarction patients,while the level of SOD[OR=0.979,95%CI(0.965,0.994),P=0.006]was a protective factor.The area under the curve of the nomograph for predicting the short term poor prognosis was 0.874[95%CI(0.812,0.936),P<0.001].The goodness-of-fit test with the calibration curve indicated that the prediction probability was consistent with the actual occurrence probability(Hosmer-Lemeshow test P=0.295),and the decision curve indicated that the nomograph had good clinical application value.Conclusion SAA and SOD have good predictive value for short-term adverse prognosis of lacunar cerebral infarction patients,and the nomograph constructed based on them has a good differentiation and consistency,which can provide a basis for clinicians to evaluate the prognosis of lacunar cerebral infarction patients.
作者
叶胜
秦宇
李韦嘉
唐晓磊
邢晶晶
潘惠卿
许利
YE Sheng;QIN Yu;LI Weijia;TANG Xiaolei;XING Jingjing;PAN Huiqing;XU Li(Emergency Department,the Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,P.R.China;Graduate School,Wannan Medical College,Wuhu,Anhui 241000,P.R.China;School of Clinical Medicine,Wannan Medical College,Wuhu,Anhui 241000,P.R.China;Translational Medicine Centre,the Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,P.R.China;Neurology Department,the Second Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241000,P.R.China)
出处
《华西医学》
CAS
2022年第11期1623-1629,共7页
West China Medical Journal
基金
皖南医学院自然科学基金重点项目(WK2021ZF24)。
