摘要
目的建立急性脑梗死(ACI)患者下肢深静脉血栓形成(LDVT)发生风险的列线图模型。方法前瞻性选择ACI患者699例,按照入组先后顺序以7∶3的比例分为训练队列(489例)与验证队列(210例)。收集所有患者的一般临床资料并分组进行比较。采用LASSO回归筛选危险因素,采用多因素logistic回归分析评估ACI患者LDVT的危险因素,分别应用受试者工作特征(ROC)曲线、Hosmer-Lemeshow拟合优度检验对构建的列线图模型在训练及验证队列中的区分度和校准度进行评价;采用决策曲线分析判断列线图的临床效能。结果年龄≥70岁、美国国立卫生研究院卒中量表(NIHSS)评分≥15分、肌力≤2级、D-二聚体>0.5 mg/L、合并心房颤动、肺部感染、未使用抗凝药物是ACI患者LDVT的危险因素(P<0.05)。训练队列和验证队列的ROC曲线下面积(AUC)分别是0.895、0.873,Hosmer-Lemeshow拟合优度检验结果显示出良好的一致性。决策曲线分析结果显示训练队列和验证队列的阈值概率区间分别为3%~90%和12%~97%时具有较高的净获益值。结论本研究建立的预测ACI患者LDVT发生风险的列线图模型有助于临床医生制定患者个体化治疗方案。
Objective To establish nomogram model for lower limb deep vein thrombosis(LDVT)in patients with acute cerebral infarction(ACI).Methods A total of 699 ACI patients were prospectively selected.According to the order of enrollment,the patients were assigned to the training cohort(489 cases)and the validation cohort(210 cases)with a ratio of 7:3.The general clinical data of all patients were collected and grouped for comparison.LASSO regression was used to screen the risk factors,and logistic regression method was used to establish the nomogram model.Receiver operating eurve(ROC)and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and calibration of the constructed nomogram model in the training and validation cohorts,respectively.Clinical decision curve analysis was used to evaluate the accuracy and stability of the nomogram.Results Age≥70 years old,National Institutes of Health Stroke Scale(NIHSS)score≥15,muscle strength≤grade 2,D-dimer>0.5 mg/L,with atrial fibillation,lung infection,without the use of anticoagulant drugs were risk factor for LDVT patients with ACI.The area under the ROC curve(AUC)of the training cohort and the validation cohort were 0.895 and 0.873,respectively,and the calibration curve showed good consistency.The results of decision curve analysis showed that when the threshold probability interval was 3%-90%in the training cohort and 12%-97%in the validation cohort,it had higher net benefit value.Conclusion The nomogram model established in this study can predict the risk of LDVT in ACI patients,which is helpful for clinicians to formulate individualized treatment plans for patients.
作者
肖一
刘萍萍
何冬梅
任瑜
季一飞
Xiao Yi;Liu Pingping;He Dongmei;Ren Yu;Ji Yifei(Department of Neurology,Nanchong Central Hospital,Nanchong 637000,China)
出处
《临床内科杂志》
CAS
2023年第5期309-312,共4页
Journal of Clinical Internal Medicine
基金
国家自然科学基金资助项目(81870966)。
