急性缺血性脑卒中机械取栓联合药物溶栓后病死风险的影响因素分析及预测模型构建

Influencing factors for mortality risk after mechanical thrombectomy combined with pharmacological thrombolysis in acute ischemic stroke and construction of a predictive model

摘要:

目的 探讨急性缺血性脑卒中（AIS）患者接受机械取栓联合药物溶栓治疗后病死的影响因素，并构建风险预测模型。方法 回顾性分析2022年12月至2025年2月邢台市中心医院收治的120例AIS患者临床资料，根据治疗后90 d生存情况分为生存组（n=106）和病死组（n=14）。收集患者的基本资料、病史、围手术期指标、术后并发症及神经功能评分等数据。采用多因素Logistic回归分析探讨病死的相关影响因素，并建立预测模型。采用受试者操作特征（ROC）曲线、曲线下面积（AUC）及Bootstrap法评价模型效能。结果 高血压、糖尿病、心房颤动、高脂血症的病史比例，以及术前及术后美国国立卫生研究院卒中量表（NIHSS）评分、阿尔伯塔卒中项目早期CT评分（ASPECTS）得分、手术时长、症状性颅内出血（sICH）发生率及肺部感染发生率在两组间比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，术后24 h NIHSS评分升高、sICH、肺部感染及高血压是治疗后病死的危险因素（P<0.05），ASPECTS得分升高是保护因素（P<0.05）。基于上述因素构建的病死预测模型的AUC为0.932，灵敏度为92.86%，特异度为90.57%，模型拟合良好。结论 术后24 h NIHSS评分升高、sICH、肺部感染及高血压可增加AIS患者机械取栓联合药物溶栓治疗后病死风险，ASPECTS得分升高与较好预后相关。基于这些因素构建的病死预测模型具有较高的预测效能，可辅助临床早期识别高危患者。

Abstract:

Objective To investigate the influencing factors for mortality after mechanical thrombectomy combined with pharmacological thrombolysis in patients with acute ischemic stroke （AIS）， and to construct a risk prediction model.Methods A retrospective analysis was performed for the clinical data of 120 patients with AIS who were admitted to Xingtai Central Hospital from December 2022 to February 2025， and according to their survival status on day 90 after treatment， they were divided into a survival group with 106 patients and a death group with 14 patients. Related data were collected， including general information， medical history， perioperative parameters， postoperative complications， and neurological function scores. A multivariate logistic regression analysis was used to identify the influencing factors for mortality， and a predictive model was constructed. The receiver operating characteristic （ROC） curve， the area under the ROC curve （AUC）， and the Bootstrap method were used to assess the predictive performance of the model.Results There were significant differences between the two groups in the proportion of patients with history of hypertension， diabetes mellitus， atrial fibrillation， and hyperlipidemia， as well as the National Institutes of Health Stroke Scale （NIHSS） score before and after surgery， Alberta Stroke Program Early Computed Tomography Score （ASPECTS）， time of operation， incidence of symptomatic intracranial hemorrhage （sICH）， and incidence of pulmonary infection （P<0.05）. The multivariate logistic regression analysis showed that an increase in NIHSS score at 24 hours after surgery， sICH， pulmonary infection， and hypertension were independent risk factors for mortality after treatment （P<0.05）， whereas an increase in ASPECTS score was a protective factor （P<0.05）. The predictive model for mortality established based on these factors had an AUC of 0.932， with a sensitivity of 92.86% and a specificity of 90.57%， and the model had a good degree of fitting.Conclusions Increase in NIHSS score at 24 hours after surgery， sICH， pulmonary infection， and hypertension can increase the risk of mortality in AIS patients after mechanical thrombectomy combined with pharmacological thrombolysis， while an increase in the ASPECTS score is associated with a relatively good prognosis. The predictive model for mortality constructed based on these factors has high predictive performance and can assist in the early identification of high-risk patients in clinical practice.