急性缺血性脑卒中病人rt-PA静脉溶栓后预后不良的列线图风险预测模型构建与评估

黄晴; 李孟磊; 胡富勇

doi:10.13898/j.cnki.issn.1000-2200.2024.06.007

急性缺血性脑卒中病人rt-PA静脉溶栓后预后不良的列线图风险预测模型构建与评估

Construction and evaluation of a nomogram risk prediction model for poor prognosis after rt-PA intravenous thrombolysis in acute ischemic stroke patients

摘要

摘要:
目的探讨急性缺血性脑卒中(AIS)病人重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后不良预后的影响因素，并构建其列线图风险预测模型。
方法将123例接受rt-PA静脉溶栓治疗的急性缺血性脑卒中病人作为研究对象，于治疗后随访3个月，根据mRS评分，分为预后良好组和预后不良组，通过单、多因素logistic模型分析其预后不良的影响因素。将回归分析中具有统计学意义的变量作为预测因子，利用R语言，构建AIS病人经rt-PA静脉溶栓治疗后预后不良的列线图风险预测模型，并对模型进行验证。
结果 123例AIS病人经rt-PA静脉溶栓治疗后3个月，预后良好97例(78.86%)，预后不良26例(21.14%)。多因素分析结果显示，GCS评分分度高、溶栓前NIHSS评分高和入院时NLR值升高均是AIS病人rt-PA静脉溶栓治疗后预后不良的危险因素(P < 0.05~P < 0.01)；ROC曲线验证列线图预测模型显示，该模型预测AIS病人经rt-PA静脉溶栓治疗后预后不良的曲线下面积为0.897(95%CI：0.827~0.968)，灵敏度为84.6%，特异度为90.7%。Bootstrap方法重复抽样1 000次验证列线图，显示该列预测模型内部验证前后的平均绝对误差为0.032。
结论 GCS评分分度高、溶栓前NIHSS评分高和入院时NLR值升高均是AIS病人rt-PA静脉溶栓治疗后预后不良的危险因素，基于这些危险因素构建的列线图风险预测模型临床准确性较高。

Abstract:
Objective To investigate the influencing factors of poor prognosis after intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA) in patients with acute ischemic stroke(AIS), and construct a nomogram risk prediction model.
Methods A total of 123 AIS patients treated with intravenous thrombolytic therapy with rt-PA were selected as the study subjects, and were followed up for 3 months after treatment.According to the mRS scores, the patients were divided into the good prognosis group and poor prognosis group.The influencing factors of poor prognosis were analyzed by univariate and multivariate logistic models.The statistically significant variables in regression analysis were used as predictors, and the R language was used to construct a nematic risk prediction model for poor prognosis of AIS patients after rt-PA intravenous thrombolytic therapy, and the model was verified.
Results After 3 months of rt-PA intravenous thrombolytic therapy, 97 patients(78.86%) had a good prognosis, and 26 patients(21.14%) had a poor prognosis.The results of multivariate analysis showed that high GCS score, high NIHSS score before thrombolysis and high NLR value at admission were all risk factors of poor prognosis of AIS patients after rt-PA intravenous thrombolysis(P < 0.05 to P < 0.01).The results of model predicted that the area under the curve of AIS patients with poor prognosis after rt-PA intravenous thrombolysis was 0.897 (95%CI: 0.827-0.968), the sensitivity was 84.6%, and the specificity was 90.7%.The Bootstrap method repeated sampling 1 000 times to verify the column diagram, and which showed that the average absolute error before and after the internal verification of the prediction model in this column was 0.032.
Conclusions The high pre-thrombolytic GCS score, NIHSS score and NLR level elevating are the risk factors of poor prognosis of AIS patients treated with rt-PA intravenous thrombolysis.The nomogram risk prediction model based on the above risk factors has high clinical accuracy in predicting the prognosis of the AIS patients treated with rt-PA thrombolysis.

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