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颈动脉支架植入术后发生血流动力学抑制的临床预测模型的构建
Building of a Clinical Prediction Model for Hemodynamic Depression after Carotid Artery Stenting

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范卫东 1   刘坤 1   乔彤 2 *  
文摘 目的分析颈动脉支架植入术(CAS)后发生血流动力学抑制(HD)的危险因素,并构建临床预测模型。方法收集2016年1月1日至2022年1月1日于南京医科大学鼓楼临床医学院血管外科、南京医科大学附属宿迁第一人民医院血管外科接受CAS的116例患者作为研究对象,按照是否发生HD分为HD组和非HD组,收集各组的临床资料、血管病变特征,应用Logistic回归进行多因素分析,确立CAS术后发生HD的独立预测因素,并构建临床预测模型。绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),评估该模型的预测效能。结果HD组患者糖尿病(P = 0.014)、吸烟比例(P = 0.037)明显低于非HD组,高血压(P = 0.031)、双侧CAS(P = 0.018)、钙化斑块(P = 0.001)、偏心性斑块(P = 0.003)、最小管腔水平至颈动脉分叉的距离< 1 cm比例(P = 0.009)明显高于非HD组;而在年龄、性别、冠心病、症状性颈动脉狭窄、狭窄程度、病变长度等方面两组间差异无统计学意义(P均> 0.05)。多因素Logistic回归分析显示糖尿病、吸烟、钙化斑块、偏心性斑块、最小管腔水平至颈动脉分叉的距离< 1 cm为HD发生的独立预测因素。ROC曲线分析显示,基于上述预测因素建立的临床预测模型AUC为0.807,95% CI为0.730 ~ 0.885,P < 0.001,当模型评分最佳截断值为12.5分时,敏感度为62.7%,特异度为87.7%。结论糖尿病、吸烟、钙化斑块、偏心性斑块、最小管腔水平至颈动脉分叉的距离< 1 cm为CAS术后发生HD的独立预测因素,基于以上因素构建的临床预测模型对CAS术后HD的发生具有良好的预测效能。
其他语种文摘 Objective To analyze the risk factors and build a clinical prediction model for hemodynamic depression(HD)after carotid artery stenting(CAS). Methods A total of 116 patients who received CAS in the Department of Vascular Surgery,Drum Tower Clinical College of Nanjing Medical University and the Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University from January 1,2016 to January 1,2022 were included in this study. The patients were assigned into a HD group and a non-HD group. The clinical baseline data and vascular disease characteristics of each group were collected,and multivariate Logistic regression was employed to identify the independent predictors of HD after CAS and build a clinical prediction model. The receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC)was calculated to evaluate the predictive performance of the model. Results The HD group had lower proportions of diabetes(P = 0.014)and smoking(P = 0.037)and higher proportions of hypertension(P = 0.031),bilateral CAS(P = 0.018),calcified plaque(P = 0.001),eccentric plaque(P =0.003),and the distance <1 cm from the minimum lumen level to the carotid bifurcation(P = 0.009)than the non-HD group. The age,sex,coronary heart disease,symptomatic carotid artery stenosis,degree of stenosis,and length of lesions had no statistically significant differences between the HD group and the non-HD group(all P > 0.05). Based on the above predictive factors, a clinical prediction model was established,which showed the AUC of 0.807 and the 95% CI of 0.730- 0.885(P < 0.001). The model demonstrated the sensitivity of 62.7% and the specificity of 87.7% when the best cut-off value of the model score reached 12.5 points. Conclusions Diabetes,smoking,calcified plaque,eccentric plaque,and the distance < 1 cm from the minimum lumen level to the carotid bifurcation are independent predictors of HD after CAS. The clinical prediction model built based on the above factors has good performance in predicting the occurrence of HD after CAS.
来源 中国医学科学院学报 ,2023,45(1):22-27 【核心库】
DOI 10.3881/j.issn.1000-503X.15059
关键词 颈动脉支架植入术 ; 血流动力学抑制 ; 危险因素 ; 预测
地址

1. 南京医科大学附属宿迁第一人民医院血管外科, 江苏, 宿迁, 223800  

2. 南京医科大学鼓楼临床医学院血管外科, 南京, 210008

语种 中文
文献类型 研究性论文
ISSN 1000-503X
学科 外科学
基金 国家自然科学基金
文献收藏号 CSCD:7419072

参考文献 共 21 共2页

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