急性脑梗死患者颈动脉易损斑块的危险因素分析及预测模型构建

Risk factor analysis and prediction model construction for vulnerable carotid plaques in patients with acute cerebral infarction

摘要:

目的 探讨急性脑梗死患者颈动脉易损斑块的危险因素，并构建风险预测模型。方法 连续纳入2023年1月至2023年10月在常德市第一人民医院就诊的急性脑梗死患者为研究对象，经彩色多普勒血流成像发现颈动脉斑块259例，根据是否出现易损斑块将患者分为易损斑块组（125例）和非易损斑块组（134例）。收集两组患者的临床资料。比较易损斑块组与非易损斑块患者基线资料的差异。采用多因素Logistic回归分析评估颈动脉易损斑块的危险因素，并基于此构建颈动脉易损斑块的风险预测模型。结果 易损斑块组男性占比、城市居民占比、吸烟史占比以及低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）、尿酸、超敏C反应蛋白（hs-CRP）水平高于非易损斑块组，差异均有统计学意义（P<0. 05）。多因素Logistic回归分析结果显示，性别（OR=4.510，P<0.001）、LDL-C（OR=2.944，P<0.001）、Hcy（OR=1.607，P<0.001）、hs-CRP（OR=1.142，P=0.004）是易损斑块的危险因素。根据危险因素构建的风险预测模型结果显示，曲线下面积为0.883，有较好的临床预测能力。结论 急性脑梗死患者颈动脉易损斑块的危险因素较多，性别、LDL-C、Hcy和hs-CRP是易损斑块的危险因素。建立包含该4个危险因素的风险预测模型，可用于预测患者发生颈动脉易损斑块的风险。

Abstract:

Objective To investigate risk factors for vulnerable carotid plaques in patients with acute cerebral infarction， and to build a risk prediction model based on them.Methods A total of 259 patients with acute cerebral infarction who had carotid artery plaques detected by color Doppler flow imaging at The First People’s Hospital of Changde City from January to October 2023 were retrospectively analyzed. They were divided into two groups based on whether their plaques were vulnerable： 125 cases in the vulnerable plaque group and 134 cases in the non-vulnerable plaque group. The clinical data of the two groups were collected. The baseline data of patients with vulnerable and non-vulnerable plaques were compared using univariable analyses. Risk factors associated with vulnerable carotid plaques were identified through a multivariable logistic regression analysis to develop a risk prediction model for the formation of vulnerable carotid plaques in acute cerebral infarction.Results The univariable analyses revealed that compared with the non-vulnerable plaque group， the vulnerable plaque group showed significantly higher proportions of males， urban residents， and smokers and significantly higher levels of low-density lipoprotein cholesterol （LDL-C）， homocysteine （Hcy）， uric acid， and high-sensitivity C-reactive protein （hs-CRP） （all P<0.05）. The multivariable logistic regression analysis showed that sex （odds ratio ［OR］=4.510， P<0.001）， LDL-C （OR=2.944， P<0.001）， Hcy （OR=1.607， P<0.001）， and hs-CRP （OR=1.142， P=0.004） were risk factors for the presence of vulnerable plaques. The risk prediction model developed based on the identified risk factors demonstrated robust predictive capacity， with the area under the curve being 0.883.Conclusions Sex， LDL-C， Hcy， and hs-CRP are risk factors for the formation of vulnerable carotid plaques in patients with acute cerebral infarction. The predictive model incorporating these four factors can be used to assess the risk of developing vulnerable carotid plaques in patients with acute cerebral infarction.