基于神经递质的风险模型在评估急性大动脉闭塞性脑梗死机械取栓患者神经功能预后中的价值

doi:10.3969/j.issn.1006-6233.2025.01.029

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摘要 目的: 构建基于神经递质的急性大动脉闭塞性脑梗死患者机械取栓后神经功能预后风险模型,并进行验证该模型的预测效能,为临床疾病管理方案制定提供指导。方法: 选取2021年1月至2023年12月于我院就诊的160例急性大动脉闭塞性脑梗死机械取栓患者,按照7∶3的比例随机分配为建模集(n=112)和验证集(n=48),根据建模集患者机械取栓后神经功能预后分为神经功能恶化组(n=43)、神经功能改善组(n=69),比较两组临床资料,经单因素、多因素Logistic回归分析影响急性大动脉闭塞性脑梗死患者机械取栓后神经功能预后的危险因素,基于上述危险因素构建急性大动脉闭塞性脑梗死患者机械取栓后神经功能预后风险模型,并经C指数(C-index)、受试者工作特征(ROC)曲线、标准曲线及决策曲线(DCA)评价模型的预测效能。结果: 建模集和验证集各临床资料比较,差异无统计学意义(P>0.05),且建模集与总体水平、验证集与总体水平比较,差异无统计学意义(P>0.05),两个数据集均具有总群体代表性。单因素、多因素Logistic回归分析,结果显示,年龄、高血压史、糖尿病史、基线NIHSS评分、SBP、LP(a)、脑神经递质DA、GABA、Glu脑电S谱值是急性大动脉闭塞性脑梗死患者机械取栓后神经功能预后恶化的危险因素(P<0.05)。使用上述危险因素构建风险模型,使用ROC曲线验证显示:训练集的曲线下面积为0.897(95%CI:0.767~0.943),验证集的曲线下面积为0.902(95%CI:0.788~0.954),二者区分度良好;使用校准曲线验证显示:训练集与验证集分析所得模型的预测值与实际值吻合较高;使用DCA分析显示:训练集与验证集的模型具有较高的临床应用价值。结论: 神经递质水平是急性大动脉闭塞性脑梗死机械取栓患者神经功能预后影响因素,基于神经递质指标构建风险模型存在评估患者机械取栓后神经功能预后风险的价值。

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关键词 ：急性大动脉闭塞性脑梗死, 机械取栓, 神经功能预后, 脑神经递质

Abstract：Objective: To construct a risk model for neurological function prognosis in patients with acute large artery occlusion cerebral infarction after mechanical thrombectomy based on brain neurotransmitters, and to verify the predictive efficiency of this model, guiding the formulation of clinical disease management regimens. Methods: One hundred and sixty patients with acute large artery occlusion cerebral infarction who underwent mechanical thrombectomy and visited our hospital from January 2021 to December 2023 were selected as research subjects. They were randomly assigned to a modeling set (n=112) and a validation set (n=48) in a 7∶3 ratio. Based on the neurological function prognosis of patients after mechanical thrombectomy in the modeling set, they were divided into a group with deteriorating neurological function (n=43) and a group with improved neurological function (n=69). Clinical data of the two groups were compared. Univariate and multivariate logistic regression analyses were conducted to identify risk factors affecting the neurological function prognosis of patients with acute large artery occlusion cerebral infarction after mechanical thrombectomy. A neurological function prognosis risk model for patients with acute large artery occlusion cerebral infarction after mechanical thrombectomy was constructed based on the identified risk factors, and the predictive performance of the model was evaluated using the C-index, receiver operating characteristic (ROC) curve, standard curve, and decision curve analysis (DCA). Results: There were no statistical differences in clinical data between the modeling set and the validation set (P>0.05), and comparisons between the modeling set and the overall level, as well as between the validation set and the overall level, revealed no statistical differences (P>0.05). Both data sets were representative of the total population. Univariate and multivariate logistic regression analyses showed that age, history of hypertension, history of diabetes, baseline NIHSS score, SBP, LP(a), brain neurotransmitters DA, GABA, Glu EEG S spectrum values were risk factors for deterioration of neurological function prognosis in patients with acute cerebral infarction caused by large artery occlusion after mechanical thrombectomy (P<0.05). The constructed risk model was verified by ROC curve analysis, which showed that the areas under the curves of the training set and the validation set were 0.897 (95%CI: 0.767-0.943) and 0.902 (95%CI: 0.788-0.954), respectively, indicating good discrimination. Calibration curve verification revealed that the predicted values of the model obtained from the training set and the validation set were in good agreement with the actual values. DCA analysis indicated that the model of the training set and validation set had high clinical application value. Conclusion: Neurotransmitter levels are influencing factors of prognosis in patients with acute large artery occlusion cerebral infarction with mechanical thrombectomy. It is valuable to construct a risk model based on neurotransmitters to evaluate the risk of neurological function prognosis in patients after mechanical thrombectomy.

Key words： Acute large artery occlusion cerebral infarction Mechanical thrombectomy Neurological function prognosis Brain neurotransmitters

基金资助:广西壮族自治区卫生健康委员会自筹经费科研课题,(编号:Z20211213)

引用本文:

桂慧华, 张彩虹, 韦俊杰, 韦敏康, 张晓航. 基于神经递质的风险模型在评估急性大动脉闭塞性脑梗死机械取栓患者神经功能预后中的价值[J]. 河北医学, 2025, 31(1): 155-164.
GUI Huihua, ZHANG Caihong, WEI Junjie, et al. Value of Neurotransmitters-Based Risk Model on Evaluating Neurological Function Prognosis in Patients with Acute Large Artery Occlusion Cerebral Infarction with Mechanical Thrombectomy. HeBei Med, 2025, 31(1): 155-164.

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