摘要
目的:基于临床资料构建急性缺血性脑卒中(AIS)患者机械取栓后出血转化(HT)预测模型及验证.方法:选择我院2021年4月至2024年5月期间收治的AIS患者151例,根据机械取栓后HT情况分为HT组和非HT组.采用多因素Logistic回归分析患者术后HT发生的影响因素.根据影响因素构建列线图预测模型,受试者工作特征(ROC)曲线分析预测模型对患者术后HT发生的预测价值.结果:151例接受机械取栓的AIS患者,有35例发生HT,HT发生率为23.18%.单因素分析显示AIS患者机械取栓后HT发生与高血压、糖尿病、取栓次数、中性粒细胞与淋巴细胞比、侧支循环情况、入院时美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分(ASPECTS)有关(P<0.05).多因素Logistic回归分析结果显示:高血压、糖尿病、取栓次数偏多、中性粒细胞与淋巴细胞比偏高、侧支循环情况不良、ASPECTS评分偏低是AIS机械取栓后HT的危险因素(P<0.05).Bootstrap内部验显示,模型预测曲线与实际曲线接近重合,Hosmer-Lemeshow x^(2)=1.321,P=0.589.ROC分析显示预测模型预测AIS患者机械取栓后HT发生的曲线下面积(AUC)值为0.920,95%CI为0.861~0.970,敏感度为91.43%,特异度为80.72%.结论:高血压、糖尿病、取栓次数偏多、中性粒细胞与淋巴细胞比偏高、侧支循环情况不良、ASPECTS评分偏低是AIS机械取栓后HT的危险因素,根据危险因素构建的预测模型对AIS患者机械取栓后HT的发生有较高的预测价值.
Objective:To construct and validate a predictive model for hemorrhagic transformation(HT)after acute ischemic stroke(AIS)mechanical thrombectomy based on clinical data.Methods:151 AIS patients who were admitted to our hospital from April 2021 to May 2024 were selected,they were divided into HT group and non HT group based on their HT status after mechanical thrombectomy.Multivariate Logistic regression was used to analyze the influencing factors of postoperative HT.Column chart prediction model were constructed based on influencing factors,the predictive value of the prediction model for HT after AIS mechanical thrombectomy was analyzed by receiver operating characteristic(ROC)curves.Results:Among 151 AIS patients who underwent mechanical thrombectomy,35 developed HT,with HT incidence rate of 23.18%.Univariate analysis showed that the occurrence of HT after AIS mechanical thrombectomy was related to hypertension,diabetes,the number of thrombectomy,the ratio of neutrophils to lymphocytes,collateral circulation,national institutes of health stroke scale(NIHSS)score upon at admission,and alberta stroke project early CT score(ASPECTS)(P<0.05).Multivariate logistic regression analysis showed that,hypertension,diabetes,more times of thrombectomy,higher ratio of neutrophils to lymphocytes,poor collateral circulation,and low ASPECTS scores were the risk factors of HT after AIS mechanical thrombectomy(P<0.05).Bootstrap's internal verification shows that,the Model prediction curve was closely with the actual curve,Hosmer-Lemeshow x^(2)=1.321,P=0.589.ROC analysis showed that the area under the curve(AUC)value of the predictive model for predicting HT after AIS mechanical thrombectomy was 0.920,with a 95%CI of 0.861-0.970,a sensitivity of 91.43%,and a specificity of 80.72%.Conclusion:Hypertension,diabetes,more times of thrombectomy,higher ratio of neutrophils to lymphocytes,poor collateral circulation,and lower ASPECTS score are the risk factors of HT after AIS mechanical thrombectomy.The prediction model based on the risk factors has a high predictive value for the occurrence of HT after AIS mechanical thrombectomy.
作者
刘春
祝青
范凯
LIU Chun;ZHU Qing;FAN Kai(Department of Neurology,Liupanshui People's Hospital,Liupanshui,Guizhou,553000,China)
出处
《现代生物医学进展》
2025年第8期1374-1380,共7页
Progress in Modern Biomedicine
基金
六盘水市科技计划项目(52020-2018-0-2-06)。
关键词
临床资料
急性缺血性脑卒中
机械取栓
出血转化
预测模型
Clinical data
Acute ischemic stroke
Mechanical thrombectomy
Hemorrhagic transformation
Prediction model
作者简介
刘春(1987-),女,本科,主治医师,主要研究方向:脑卒中,E-mail:15608588580163.com。
