摘要
目的建立动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者迟发性脑缺血(delayed cerebral ischemia,DCI)的Nomogram预测模型。方法回顾性分析210例aSAH患者资料,根据是否发生DCI分为DCI组(n=50)和非DCI组(n=160),比较两组分子生物学指标、临床特征,应用Lasso回归与Logistic回归分析aSAH患者发生DCI的影响因素,根据影响因素建立aSAH患者发生DCI的Nomogram预测模型。结果aSAH患者术后30d内DCI发生率23.81%。低钠血症、低蛋白血症、Hunt-Hess分级、Fisher分级、世界神经外科联盟(World Federation of Neurosurgery,WFNS)分级以及入院时血清白介素-6(interleukin-6,IL-6)、C反应蛋白(creactive protein,CRP)、可溶性凝集素样氧化低密度脂蛋白受体-1(soluble lectinlike oxidized low density lipoprotein receptor-1,sLOX-1)、缺氧诱导因子1α(hypoxia inducible factor 1α,HIF-1α)、内皮素1(endothelin-1,ET-1)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平均为aSAH患者发生DCI的影响因素(均P<0.05)。根据影响因素建立aSAH患者发生DCI的Nomogram预测模型,该模型曲线下面积(area under the curve,AUC)为0.908,具有较高预测效能,且具有良好临床效用,预测aSAH患者发生DCI的结果与实际情况具有较高符合率。结论低钠血症、低蛋白血症、Hunt-Hess分级、Fisher分级、WFNS分级以及入院时血清IL-6、CRP、sLOX-1、HIF-1α、ET-1、IGF-1水平均为aSAH患者发生DCI的影响因素,据此建立Nomogram预测模型可为临床早期识别DCI高危患者提供可靠临床依据。
Objective To establish a Nomogram prediction model for delayed cerebral ischemia(DCI)in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods Clinical data of 210 patients with aSAH were analyzed retrospectively,who were divided into the DCI group(n=50)and the non-DCI group(n=160)based on the occurrence of DCI.Molecular biological indicators and clinical characteristics were compared between the two groups.Lasso regression and Logistic regression analysis was applied to identify the influencing factors for DCI in aSAH patients.A nomogram prediction model for DCI in aSAH patients was then established based on these influencing factors.Results The incidence of DCI within 30 days postoperatively in aSAH patients was 23.81%.Hyponatremia,hypoproteinemia,Hunt-Hess grade,Fisher grade,World Federation of Neurosurgery(WFNS)grade,as well as serum levels of interleukin-6(IL-6),C-reactive protein(CRP),soluble lectin-like oxidized low density lipoprotein receptor-1(sLOX-1),hypoxia inducible factor 1α(HIF-1α),endothelin-1(ET-1),and insulin-like growth factor-1(IGF-1)at admission were all identified as influencing factors for DCI in aSAH patients(all P<0.05).A nomogram prediction model for DCI in aSAH patients was established based on these influencing factors.The model exhibited a high predictive efficacy with an area under the curve(AUC)of 0.908 and demonstrated good clinical utility,showing a high concordance rate between predicted and actual occurrences of DCI in aSAH patients.Conclusions Hyponatremia,hypoproteinemia,Hunt-Hess grade,Fisher grade,WFNS grade,as well as serum levels of IL-6,CRP,sLOX-1,HIF-1α,ET-1,and IGF-1 at admission are all influencing factors for DCI in aSAH patients.The established nomogram prediction model provides a reliable clinical basis for early identification of high-risk patients with DCI in clinical practice.
作者
冯翠玲
田金英
王书峰
方丹东
Feng Cuiling;Tian Jinying;Wang Shufeng;Fang Dandong(Neurocritical Care Unit,Sanmenxia Central Hospital,Sanmenxia,Henan 472099,China)
出处
《中国微侵袭神经外科杂志》
2025年第5期298-304,共7页
Chinese Journal of Minimally Invasive Neurosurgery
基金
2022年度河南省医学科技攻关计划软科学项目、联合共建项目(编号:LHGJ20221037)。
关键词
蛛网膜下腔出血
迟发性脑缺血
列线图
预测
subarachnoid hemorrhage
delayed cerebral ischemia
nomogram
prediction
