作者：周娟娟，王翠琴，朱胜康，钱芬涛，江铃

单位：

244000安徽省铜陵市立医院急诊科

Units：

Emergency Department, Tongling Municipal Hospital, Tongling 244000, China

关键词：

缺血性脑卒中；复发；预测模型；影响因素分析

Keywords：

Ischemic stroke; Recurrence; Prediction model; Root cause analysis

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2022.00.037

Funds：

安徽省重点研究和开发计划项目（1804h08020262）

摘要：

背景　目前，城乡脑卒中死亡率已位居我国疾病死亡的首位。既往研究表明，年龄、性别、高血压 等是缺血性脑卒中复发的影响因素，在此基础上本研究增加了观察指标，旨在为识别缺血性脑卒中高复发风险人群 提供参考。目的　探讨缺血性脑卒中复发的影响因素并构建预测模型，旨在为识别缺血性脑卒中高复发风险人群提 供参考。方法　选取2016—2017年铜陵市立医院神经内科收治的缺血性脑卒中患者538例，根据患者随访５年复发 情况分为复发组和未复发组。比较两组患者的临床资料，采用多元Cox比例风险回归分析探讨缺血性脑卒中复发的 影响因素，并基于其影响因素构建预后指数（PI）方程，绘制受试者工作特征（ROC）曲线以分析PI方程对缺血性 脑卒中复发的预测价值。结果　随访5年，失访29例（5.39%），复发127例（23.61%）。复发组患者年龄大于未 复发组，高血压、糖尿病、心脏病发生率及收缩压、平均动脉压、动脉压指数、总胆固醇水平、低密度脂蛋白胆 固醇水平、尿酸水平高于未复发组（P ＜0.05）。多元Cox比例风险回归分析结果显示，年龄〔HR =2.793，95%CI （2.696，2.893）〕、高血压〔HR =10.444，95%CI （4.540，24.023）〕、糖尿病〔HR =5.557，95%CI （2.532， 12.194）〕、心脏病〔HR =5.078，95%CI （3.339，7.725）〕、总胆固醇〔HR =4.874，95%CI （3.528，6.736）〕 是缺血性脑卒中复发的独立影响因素（P ＜0.05）。将上述影响因素依次作为协变量X1 、X2 、X3 、X4 、X5 构建缺 血性脑卒中复发的PI方程，PI =2.793X1 ＋10.444X2 ＋5.557X3 ＋5.078X4 ＋4.874X5 。ROC曲线分析结果显示，PI方 程预测缺血性脑卒中复发的曲线下面积为0.861〔95%CI （0.820，0.901）〕。结论　年龄、高血压、糖尿病、心脏病、总 胆固醇水平是缺血性脑卒中复发的独立影响因素，针对上述影响因素构建的PI方程对缺血性脑卒中复发具有一定预测价 值，提示针对缺血性脑卒中患者，需关注其年龄、血压、血糖、血脂及合并症等情况，以识别高复发风险人群。

Abstract：

Background　The mortality rate of stroke in urban and rural areas has ranked the first of disease death in China at present. Previous studies had shown that various factors such as age, gender, and hypertension were influencing factors of the recurrence of ischemic stroke. On this basis, the present study provides additional observational indicators, aiming to provide a reference for identifying people with high-risk of recurrence of ischemic stroke. Objective　To discuss the influencing factors of recurrence of ischemic stroke and constructs its prediction model, in order to provide reference for identifying people with highrisk of recurrence of ischemic stroke. Methods　There were 538 cases of ischemic stroke patients admitted to the Department of Neurology of Tongling Municipal Hospital from 2016 to 2017, and the patients were divided into recurrence group and nonrecurrence group according to their recurrence status at 5 years of follow-up. Clinical data of the two groups were compared,and influencing factors of the recurrence of ischemic stroke were analysed by multivariate Cox proportional risk regression, then constructed prognostic index (PI) equation based on above the influencing factors, receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of this PI equation for ischemic stroke recurrence. Results　At 5 years of followup, 29 cases (5.39%) were lost, 127 cases (23.61%) were recurred. Age in the recurrence group was older than that in the nonrecurrence group, incidence of hypertension, diabetes mellitus, heart disease, and systolic blood pressure, mean arterial pressure, arterial pressure index, total cholesterol level, low density lipoprotein cholesterol level and uric acid level were higher than those in the non-recurrence group (P < 0.05) . The results of multivariate Cox proportional risk regression analysis showed that age [HR =2.793, 95%CI (2.696, 2.893) ] , hypertension [HR =10.444, 95%CI (4.540, 24.023) ] , diabetes mellitus [HR =5.557, 95%CI (2.532, 12.194) ] , heart disease [HR =5.078, 95%CI (3.339, 7.725) ] , total cholesterol level [HR =4.874, 95%CI (3.528, 6.736) ] were influencing factors of the recurrence of ischemic stroke (P < 0.05) . The above influencing factors were regarded as covariates X1, X2, X3, X4, X5 to construct PI equation, PI=2.793 X1 + 10.444X2 + 5.557X3 + 5.078X4 + 4.874X5 . The result of ROC curve analysis showed that the area under curve of PI equation in predicting ischemic stroke recurrence was 0.861 [95%CI (0.820, 0.901) ] . Conclusion　Age, hypertension, diabetes mellitus, heart disease, total cholesterol level are influencing factors of the recurrence of ischemic stroke, the PI equation constructed based on the above influencing factors has some predictive value for ischemic stroke recurrence, suggesting the importance of paying attention to age, blood pressure, blood glucose, lipids and complications in patients with ischemic stroke, to identify those with high-risk of recurrence.

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