急性缺血性卒中患者静脉溶栓后抑郁发生及预测模型的建立分析

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摘要目的：分析急性缺血性卒中（AIS）患者静脉溶栓后抑郁发生及预测模型的建立。方法：选取2020年1月―2021年12月绵阳市第三人民医院收治的行静脉溶栓治疗的AIS患者243例为研究对象,根据有无静脉溶栓后抑郁症发生分为抑郁症组（n=78）和非抑郁症组（n=165）,比较两组基线资料,采用Logistic回归分析AIS静脉溶栓后抑郁症发生的影响因素,构建预测模型,受试者工作特征（ROC）曲线评估模型预测价值。结果：单因素分析显示,两组患者年龄、BMI、陪护方式、近期有无负性生活事件发生、入院时NIHSS评分、溶栓后并发症比较差异均有统计学意义。Logistic回归分析显示,年龄≥60岁、BMI≥28 kg/m²、陪护方式为护工陪护、近期有负性生活事件发生、入院时NIHSS评分>5分、溶栓后出血和溶栓后缺血再灌注损伤是AIS静脉溶栓后抑郁症发生的危险因素。根据上述因素构建预测模型,采用Bootstrap法进行内部验证显示预测曲线与标准模型曲线拟合度好,ROC曲线分析显示,指标Prob的灵敏度为86.00%,特异度为70.50%。结论：年龄、BMI、陪护方式、近期有无负性生活事件、入院时NIHSS评分、溶栓后并发症是AIS患者静脉溶栓后抑郁症发生的影响因素,以上述因素构建的预测模型对预测AIS静脉溶栓后抑郁症具有一定参考价值。

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	陈娆
	彭金凤
	申婷

关键词：急性缺血性卒中,静脉溶栓,抑郁症,影响因素,预测模型建立

Abstract：ObjectiveTo analyze the occurrence of depression in patients with acute ischemic stroke (AIS) after intravenous thrombolysis, and construct a prediction model.MethodsA total of 243 patients with AIS who underwent intravenous thrombolysis in the Third Hospital of Mianyang from January 2020 to December 2021 were selected as the study subjects. According to the presence or absence of depression after intravenous thrombolysis, the patients were divided into depression group (n=78) and non-depression group (n=165). Baseline data of the two groups were compared. Logistic regression analysis was conducted to identify the influencing factors of depression after intravenous thrombolysis for AIS, and a prediction model was constructed. The predictive value of the model was evaluated using the receiver operating characteristic (ROC) curve.ResultsUnivariate analysis showed that there were statistically significant differences between the two groups in terms of age, BMI, accompanying mode, recent occurrence of negative life events, NIHSS score at admission and complications after thrombolysis. Logistic regression analysis found that age ≥ 60 years old, BMI ≥ 28 kg/m², accompanied by nursing workers, negative life events occurring recently, the NIHSS score higher than 5 at admission, hemorrhage and ischemia-reperfusion injury after thrombolysis were risk factors for depression in patients with AIS after intravenous thrombolysis. A prediction model was constructed based on above-mentioned factors, and internal verification by Bootstrap method showed that the prediction curve was in good agreement with the standard model curve. ROC curve analysis showed that the sensitivity and specificity of the indicator Prob were 86.00% and 70.50%.ConclusionAge, BMI, accompanying mode, presence or absence of negative life events recently, the NIHSS score at admission and complications after thrombolysis are influencing factors of depression in patients with AIS after intravenous thrombolysis. The prediction model constructed based on above factors provides certain reference for predicting depression in AIS after intravenous thrombolysis.

Key words：acute ischemic stroke intravenous thrombolysis depression influencing factor construction of prediction model

收稿日期:2023-08-03

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R743.3

基金资助:2019年四川省高校人文社会科学重点研究基地科研项目（CSXL-193012）

通讯作者:彭金凤,E-mail：420289830@qq.com

引用本文:

陈娆, 彭金凤, 申婷. 急性缺血性卒中患者静脉溶栓后抑郁发生及预测模型的建立分析[J]. 金宝搏官方188学报(医学版), 2023, 20(5): 121-124. CHEN Rao, PENG Jinfeng, SHEN Ting. Occurrence of depression in patients with acute ischemic stroke after intravenous thrombolysis and construction of prediction model. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(5): 121-124.

链接本文:

http://yxb.hunnu.edu.cn/CN/或http://yxb.hunnu.edu.cn/CN/Y2023/V20/I5/121

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