颅内动脉瘤破裂介入治疗后神经系统并发症列线图预测模型的建立

来源 :中国综合临床 | 被引量 : 0次 | 上传用户:chengjiangjie
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:探讨颅内动脉瘤破裂(rupture intracranial aneurysms,RIAs)介入治疗后神经系统并发症的危险因素,并建立列线图预测模型。方法:回顾性研究2016年1月至2019年1月在新乡医学院附属南阳市第二人民医院89例行血管内治疗的RIAs患者临床资料,收集相关临床影像资料并进行为期6个月的术后随访,分为无神经相关并发症组(61例)和有神经相关并发症组(28例)。分析临床各指标与RIAs介入治疗术后神经相关并发症的可能有关因素;依据多因素Logistic回归分析结果,建立列线图对各影响因素进行评分,构建评分预测模型;通过一致性系数(consistency index,C-index)和校准曲线来评估模型的临床校准度,通过列线图依赖ROC曲线来评估模型的临床区分度。结果:多因素Logistic回归分析结果显示,Hunt-Hess分级(n OR=4.927,95%n CI:1.189~20.426,n P=0.028)、Fisher分级(n OR=4.633,95%n CI:1.012~21.208,n P=0.048)、动脉瘤囊小阜(n OR=5.918,95%n CI:1.104~24.948,n P=0.015)、宽颈动脉瘤(n OR=4.381,95%n CI:1.029~18.645,n P=0.046)以及治疗策略(n OR=4.887,95%n CI:1.235~19.329,n P=0.024)是RIAs介入治疗术后神经相关并发症的独立危险因素。列线图预测模型显示,Hunt-Hess分级(Ⅳ、Ⅴ级)为100分、动脉瘤囊小阜(有)为98分、治疗策略(支架植入)95分、宽颈动脉瘤(是)92分、Fisher分级(Ⅲ、Ⅳ级)为81分;该预测模型的一致性系数为0.871;列线图依赖ROC曲线AUC为0.871,对应的敏感度、特异度分别为85.71%(24/28)、77.05%(47/61)。n 结论:Hunt-Hess分级、Fisher分级、动脉瘤囊小阜、宽颈动脉瘤以及治疗策略会影响RIAs介入治疗术后神经相关并发症的发生,以此建立的列线图能够为临床提供直观可靠的参考依据。“,”Objective:To explore the risk factors of neurological complications after interventional treatment of ruptured intracranial aneurysms(RIAS), and to establish a predictive model of nomogram.Methods:The clinical data of 89 patients with RIAS who underwent endovascular treatment in Nanyang Second General Hospital Affiliated to Xingxiang Medical University from January 2016 to January 2019 were retrospectively studied.The clinical imaging data were collected and followed up for 6 months.The patients were divided into two groups: no neurological complications group (61 cases) and neurological complications group (28 cases). To analyze the clinical indicators and the possible related factors of neurological complications after RIAS interventional therapy.A nomogram was established to score the influencing factors, and a scoring prediction model was constructed; the clinical calibration of the model was evaluated by consistency index (C-index) and calibration curve, and the clinical differentiation of the model was evaluated by nomogram relying on ROC curve.Results:Multivariate logistic regression analysis showed that Hunt-Hess classification (n OR=4.927, 95%n CI: 1.189-20.426, n P=0.028), Fisher classification (n OR=4.633, 95%n CI: 1.012-21.208, n P=0.048 ), aneurysm cyst xiaofu (n OR=5.918, 95%n CI: 1.104-24.948, n P=0.015), wide carotid aneurysm (n OR=4.381, 95%n CI: 1.029-18.645, n P=0.046) and treatment Strategy (n OR=4.887, 95%n CI: 1.235-19.329, n P=0.024) is an independent risk factor for nerve-related complications after RIAs interventional therapy.The predictive model of nomogram showed that Hunt-Hess classification (grade IV, V) was 100, aneurysm bleb (with) 98, treatment strategy (stent implantation) 95, wide-necked aneurysm (yes) 92 and Fisher grade (grade III, IV) 81; the C-index of the predictive model was 0.871; the nomogram relied on ROC curve AUC 0.871, and the treatment strategy (stent implantation) was 95; the Fisher grade (grade III, IV) was 81; the C-index of the predictive model was 0.871.The sensitivity and specificity were 85.71%(24/28) and 77.05%(47/61) respectively.n Conclusion:Hunt Hess classification, Fisher classification, aneurysmal sac caruncle, wide necked aneurysms and treatment strategies will affect the occurrence of neurological complications after RIAS interventional therapy.The nomogram established by this method can provide intuitive and reliable reference for clinical practice.
其他文献
Objective: To review the prevalence of cryptosporidiosis among animal population of Iran.Methods: Data were systematically gathered from 1 January 2000 to 1 Jan
明星孝语:父母付出的心血,我都一一记在心里。     孝敬长辈  刘翔住在上海普陀区金沙路。一套不到80平米,两居室的房子,很难想象,那就是中国“跨栏王子”的家。父亲刘学根是自来水公司的一位普通司机,母亲吉粉花也下岗了一段时间,刘翔的家庭并不宽裕。因为这样,刘翔一直有个心愿,用自己的努力,为爸妈买套大房子。每次刘翔出国比赛,总惦记着给妈妈带礼物。   记得有一次吉粉花无意间跟儿子开玩笑:“我有一个
目的 临床中很多急性缺血性脑卒中患者都会出现早期神经功能恶化等情况,导致患者的生活质量和身体健康受到严重影响,为提高患者的治疗效果,改善疾病情况,本文在此基础上分析
因果报应是杨董氏的人生信条,所以她心境开阔,坚持与人为善,也就有了百岁寿星这个善果。其实,一个人只要保持良好的心态,不去计较生活中的得与失,生活自然就充满了阳光。王之干就是基于这种心态,从而成为了一位百岁寿星。    一个已经104岁的老人,每天除了照顾自己的生活,还得照顾生病的女儿,接送曾孙子上学放学,家务事忙完后,打开台灯,开始伏案写作,经过3年的时间,老人竟然完成了一部10多万字的英语语法教
村前河边的柳树下,一对热恋中的年轻人在低语。“结婚后,你能来我家当上门女婿,与我一起照料瘫痪的父亲和年迈的奶奶吗?”杜友英问依在身旁的男友陈光文。“愿意,既然我爱上你,也就爱上了你们这个家,我不怕苦、不怕累,还相信,今后通过我们的共同努力,这个家是永远也不会倒下的!”男友坚定地说。   杜友英家住兴义市下午屯办事处耳寨村。9年前,她的父亲在从兴义办事回来的路上,被一沙石厂拉沙的拖拉机撞成严重伤残。