基于肢体肌力状况联合临床资料构建的预测模型在脑卒中急性期发生深静脉血栓的应用价值

Application value of prediction model established based on limb muscle strength status combined with clinical data for occurrence of deep vein thrombosis in acute stage of stroke

  • 摘要:
    目的  探讨肢体肌力状况联合临床资料构建预测模型在脑卒中急性期发生深静脉血栓(DVT)的应用价值。
    方法  回顾性分析697例脑卒中患者的临床资料,按7∶3随机将其分为建模组488例和验证组209例,并分析2组资料有无差异。建模组中以患者急性期是否发生DVT划分为DVT组、非DVT组。采用多因素Logistic回归分析筛选出脑卒中急性期发生DVT的影响因素,利用R软件获得以列线图表达的预测模型。采用受试者工作特征(ROC)曲线评估模型的区分度。采用Bootstrap法(自抽样法)评价模型的校准度; 采用决策曲线评价模型的临床有效性。
    结果  建模组与验证组的临床资料比较,差异无统计学意义(P>0.05)。建模组488例脑卒中患者急性期住院期间内,有77例发生DVT(DVT组),发生率为15.78%(77/488)。Logistic回归分析发现年龄、合并糖尿病、血脂异常、Padua评分、D-二聚体、肢体肌力均是脑卒中急性期DVT的影响因素(P < 0.05)。建模组发生DVT风险的曲线下面积为0.890(95%CI: 0.866~0.923), 验证组发生DVT风险的曲线下面积为0.851(95%CI: 0.781~0.911), 表明模型的区分度良好; Bootstrap法验证发现建模组和验证组的偏差校准曲线平均绝对误差分别为0.012、0.015, 表明预测模型的校准度高。决策曲线中的阀概率值设定为33%, 建模组与验证组的临床净获益分别为62%和64%, 表明预测模型具有临床有效性。
    结论  基于肢体肌力状况、年龄、有无糖尿病和血脂异常、Padua评分、D-二聚体指标建立的预测模型对脑卒中急性期发生DVT风险具有一定的预测价值。

     

    Abstract:
    Objective  To explore the application value of the prediction model established based on limb muscle strength combined with clinical data in the occurrence of deep vein thrombosis (DVT) in acute stage of stroke.
    Methods  Clinical data of 697 stroke patients were retrospectively analyzed, and they were randomly divided into modeling group (n=488) and validation group (n=209) according to a ratio of 7∶3, and the data of the two groups were analyzed for differences. The modeling group was divided into DVT group and non-DVT group according to whether patients had DVT in the acute stage. Multiple Logistic regression analysis was used to screen out the influencing factors of DVT in acute stage of stroke, and R software was used to obtain the prediction model expressed in line graph. Receiver operating characteristic (ROC) curve was used to evaluate the model differentiation. The calibration degree of the model was evaluated by Bootstrap method (self-sampling method); the decision curve was used to evaluate the clinical effectiveness of the model.
    Results  There was no significant difference in clinical data between the modeling group and the verification group (P>0.05). In the modeling group, 77 of 488 stroke patients developed DVT during acute hospitalization (DVT group), with an incidence of 15.78% (77/488). Logistic regression analysis showed that age, diabetes mellitus, dyslipidemia, Padua score, D-dimer and limb muscle strength were all influencing factors of DVT in acute stage of stroke (P < 0.05). The area under the curve of DVT risk in the modeling group was 0.890 (95%CI, 0.866 to 0.923), and was 0.851 (95%CI, 0.781 to 0.911) in the verification group, which indicated that the model was well differentiated; the average absolute error of deviation calibration curve of the modeling group and the verification group was 0.012 and 0.015, respectively, which indicated that the calibration degree of the prediction model was high. The threshold probability value in the decision curve was set at 33%, and the net clinical benefit for the modeling group and the validation group was 62% and 64%, respectively, which indicated that the prediction model was effective in clinic.
    Conclusion  The prediction model established based on limb muscle strength status, age, diabetes and dyslipidemia, Padua score and D-dimer index has certain value in predicting the risk of DVT in acute stage of stroke.

     

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