老年急性前循环缺血性脑卒中患者3年内再发卒中预测模型的构建与验证

doi:10.3969/j.issn.1003-9198.2026.07.012

摘要/Abstract

摘要： 目的构建并验证适用于老年急性前循环缺血性脑卒中(AIS)患者3年内再发卒中的风险预测模型。方法回顾性纳入2021年1月至2022年6月广东医科大学附属第二医院收治的281例前循环AIS患者为研究对象。基于36个月随访数据,将患者分为再发组与非再发组。通过单因素及多因素logistic回归分析,明确老年患者3年内再发卒中的独立危险因素,并构建列线图预测模型,进而通过校准曲线、AUC及决策曲线(DCA)进行内部验证。结果 281例老年前循环AIS患者中共93例(33.09%)3年内再发卒中。多因素logistic回归分析结果显示,发病至入院时间、改良Barthel指数(MBI评分)、hs-CRP以及丙二醛(MDA)为前循环AIS患者3年内再发卒中风险的独立危险因素(P＜0.05),舒张末期流速(Vd)、超氧化物歧化酶(SOD)则为独立保护因素(P＜0.05)。模型内部性能评估结果显示,该模型的Brier分数为0.0146,校准斜率为1.0073,校准截距为-0.0024;ROC曲线分析表明,该模型预测老年前循环AIS患者3年内再发卒中风险的AUC为0.978(95%CI:0.956~0.983);经1000次Bootstrap内部验证后,该列线图模型的校正AUC为0.942(95%CI:0.921~0.965);DCA进一步证实,该模型在广泛的阈值概率范围内均表现出良好的临床净获益。结论基于MBI评分、MDA、hs-CRP、Vd、发病至入院时间和SOD构建的列线图模型能够准确评估老年前循环AIS患者3年内再发卒中的风险,具有较好的预测效能和临床实用价值。

关键词: 急性缺血性脑卒中, 再发卒中, 临床参数, 血流动力学参数, 列线图

Abstract: Objective To construct and validate of a 3-year recurrent stroke prediction model for elderly patients with acute ischemic stroke (AIS) involving the anterior circulation. Methods A total of 281 patients with anterior circulation AIS admitted to the Second Affiliated Hospital of Guangdong Medical University from January 2021 to June 2022 were retrospectively included as the research subjects. Based on the 36-month follow-up data, the patients were divided into the recurrence group and the non-recurrence group. Univariate and multivariate logistic regression analysis were used to investigate the independent risk factors for recurrent stroke in elderly patients within 3 years, and a nomogram prediction model was constructed. Subsequently, internal validation was conducted through calibration curves, area under the curve (AUC), and decision curve analysis (DCA). Results Among 281 patients, 93 (33.09%) elderly patients with anterior circulation AIS experienced recurrent stroke within 3 years. The results of multivariate logistic regression analysis showed that the time from onset to admission, modified Barthel index(MBI), high-sensitivity C-reactive protein and malondialdehyde (MDA) were independent risk factors for the risk of recurrent stroke within 3 years in patients with anterior circulation AIS (P<0.05), while end-distolic velocity (Vd) and superoxide dismutase (SOD) were independent protective factors (P<0.05). The internal performance evaluation results of the model showed that the Brier score of this model was 0.0146, the calibration slope was 1.0073, and the calibration intercept was -0.0024. The receiver operating characteristic curve indicated that the AUC value of this model for the risk of recurrent stroke within 3 years in elderly patients with anterior circulation AIS was 0.978 (95%CI:0.956-0.983). After 1000 internal validations by Bootstrap, the corrected AUC of this nomogram model was 0.942 (95%CI:0.921-0.965). DCA further confirmed that the model demonstrated good clinical net benefits over a wide range of threshold probabilities. Conclusions The nomogram model based on the time from onset to admission, MBI scores, MDA, hs-CRP, Vd, and SOD accurately assesses the risk of recurrent stroke within 3 years in elderly patients with anterior ciculation AIS, demonstrating good predictive efficacy and clinical utility.

Key words: acute ischemic stroke, recurrent stroke, clinical parameter, hemodynamic parameter, nomogram

中图分类号:

R 743

陈明华, 林军, 林日清, 周海红. 老年急性前循环缺血性脑卒中患者3年内再发卒中预测模型的构建与验证[J]. 实用老年医学, 2026, 40(7): 708-713.

CHEN Minghua, LIN Jun, LIN Riqing, ZHOU Haihong. Development and validation of a 3-year recurrent stroke prediction model for elderly patients with acute anterior circulation ischemic stroke[J]. Practical Geriatrics, 2026, 40(7): 708-713.

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