作者：张倩，魏朝洁，黄宏汰，阮贞，庞舒娴，汪莉

单位：

1.广西中医药大学护理学院2.广西壮族自治区南宁市第二人民医院神经内科3.广西壮族自治区南宁市第二人民医院护理部

单位（英文）：

1.School of Nursing, Guangxi University of Chinese Medicine, Nanning 530000, China 2.Department of Neurology, the Second Nanning People's Hospital, Nanning 530000, China 3.Nursing Department, the Second Nanning People's Hospital, Nanning 530000, China

关键词：

缺血性卒中; 复发; 中国; 预测; 危险性评估; 模型;

关键词（英文）：

　Ischemic stroke; Recurrence; China; Forecasting; Risk assessment; Model

中图分类号：

　R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.055

基金项目：

广西科技计划项目（桂科AB18221006，桂科AA22096032）

摘要：

目的 通过21个队列研究确定中国缺血性脑卒中(IS)患者复发的影响因素，并基于上述影响因素构建中国IS患者复发风险预测模型，同时验证其预测效能。方法 计算机检索中国知网、中国生物医学文献数据库、维普网、万方数据知识服务平台、PubMed、Embase、Web of Science、Cochrane Library公开发表的关于IS患者复发影响因素的文献，检索时限为2012年1月至2022年1月，并手动检索相应参考文献。由2名具有循证护理学习经验的研究者进行文献筛选、资料提取和文献质量评价，运用Stata 20.0软件进行Meta分析。采用Begg’s检验和Egger’s检验分析报道IS患者复发影响因素的文献的发表偏倚。基于Meta分析结果构建中国IS患者复发风险预测模型。回顾性选取2021年3月至2022年3月南宁市第二人民医院收治的IS患者348例作为验证集。采用ROC曲线、Hosmer-Lemeshow检验、校准曲线评估中国IS患者复发风险预测模型预测验证集IS患者复发的效能。结果 Meta分析结果显示，年龄≥60岁、饮酒、吸烟、高血压、糖尿病、冠心病、心房颤动、短暂性脑缺血发作(TIA)、高同型半胱氨酸血症(HHcy)是IS患者复发的危险因素，规律运动、抗血栓治疗是IS患者复发的保护因素(P<0.05)。Begg’s检验和Egger’s检验结果显示，报道IS患者复发影响因素的文献无发表偏倚(P值均>0.05)。根据Meta分析结果，构建中国IS患者复发风险预测模型。ROC曲线分析结果显示，中国IS患者复发风险预测模型预测验证集IS患者复发的AUC为0.909[95%CI(0.838,0.980)]。Hosmer-Lemeshow检验结果显示，χ2=9.892,P=0.195。校准曲线分析结果显示，中国IS患者复发风险预测模型预测验证集IS患者的复发率与实际复发率基本相符。结论 本研究基于21个队列研究构建的中国IS患者复发风险预测模型由11个变量组成，包括年龄≥60岁、饮酒、吸烟、高血压、糖尿病、冠心病、心房颤动、TIA、HHcy、规律运动及抗血栓治疗。其对IS患者复发具有良好的预测效能和区分度，可以为临床医护人员筛选、管理IS复发高危患者提供循证支持，并为健康教育和行为干预策略的制订提供依据。

英文摘要：

　Objective To determine the influencing factors of recurrence in Chinese patients with ischemic stroke (IS) through 21 cohort studies and construct a recurrence risk prediction model for patients with IS in China and verify its predictive efficacy. Methods The literature on the factors affecting recurrence in IS patients published by CNKI, China Biology Medicine disc, VIP, Wanfang Data, PubMed, Embase, Web of Science and Cochrane Library were retrieved by computer. The search period was from January 2012 to January 2022, and the corresponding references were manually retrieved. Literature screening, data extraction and literature quality evaluation were conducted by 2 researchers with evidence-based nursing learning experience. Stata 20.0 software was used for meta-analysis. Begg's test and Egger's test were used to analyze the publication bias of literature reporting the influencing factors of recurrence in IS patients. Based on the results of meta-analysis, the recurrence risk prediction model of patients with IS in China was constructed. A total of 348 IS patients admitted to the Second Nanning People's Hospital from March 2021 to March 2022 were retrospectively selected as the validation set. ROC curve, Hosmer- Lemeshow test and calibration curve were used to evaluate the efficacy of recurrence risk prediction model for patients with IS in China in predicting the recurrence of IS patients in the validation set. Results Meta-analysis results showed that age ≥ 60 years old, drinking, smoking, hypertension, diabetes, coronary heart disease, atrial fibrillation, transient ischemic attack (TIA) and hyperhomocysteinemia (HHcy) were risk factors for recurrence of IS patients, while regular exercise and antithrombotic therapy were protective factors for recurrence of IS patients (P < 0.05) . Begg's test and Egger's test showed that there was no publication bias in literature eporting the influencing factors of recurrence in IS patients (P values were both > 0.05) . According to the results of the meta-analysis, a recurrence risk prediction model for patients with IS in China was constructed. ROC curve analysis results showed that the AUC of recurrence risk prediction model for patients with IS in China in predicting the recurrence of IS patients in the validation set was 0.909 [95%CI (0.838, 0.980) ] . Hosmer-Lemeshow test showed that χ2 =9.892, P=0.195. The results of the calibration curve analysis showed that the recurrence rate predicted by recurrence risk prediction model for patients with IS in China was basically consistent with the actual recurrence rate of IS patients in the validation set. Conclusion The recurrence risk prediction model for patients with IS in China established based on 21 cohort studies in this study is consisted of 11 variables, including age ≥ 60 years old, drinking, smoking, hypertension, diabetes, coronary heart disease, atrial fibrillation, TIA, HHcy, regular exercise and antithrombotic therapy. It has good predictive efficacy and discrimination for the recurrence of IS patients, can provide evidence-based support for clinical medical staff to screen and manage high-risk patients with IS recurrence, and provide basis for health education and behavioral intervention strategies.

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