[1]王晨潮,李红伟,李魁元,等.烟雾病术后脑梗死列线图模型的建立与验证[J].卒中与神经疾病杂志,2022,29(04):333-337.[doi:10.3969/j.issn.1007-0478.2022.04.006]
　Wang Chenchao,Li Hongwei,Li Kuiyuan,et al.Development and validation of a nomogram to predict postoperative cerebral infarction for patients with Moyamoya disease[J].Stroke and Nervous Diseases,2022,29(04):333-337.[doi:10.3969/j.issn.1007-0478.2022.04.006]
点击复制

烟雾病术后脑梗死列线图模型的建立与验证()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第29卷
期数:
2022年04期
页码:
333-337
栏目:
论著
出版日期:
2022-09-10

文章信息/Info

Title:
Development and validation of a nomogram to predict postoperative cerebral infarction for patients with Moyamoya disease
文章编号:
1007-0478(2022)04-0333-05
作者:
王晨潮; 李红伟; 李魁元; 刘二勇; 尤浩君; 张志中; 杨波
450053 郑州大学第一附属医院神经外科[王晨潮 李红伟 李魁元 刘二勇 尤浩君 张志中 杨波(通信作者)]
Author(s):
Wang Chenchao;  Li Hongwei;  Li Kuiyuan;  et al.
Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450053
关键词:
烟雾病; 术后; 脑梗死; 列线图; 危险因素
Keywords:
Moyamoya disease Postoperative Cerebral infarction Nomogram Risk factor
分类号:
R743.4 R743.3
DOI:
10.3969/j.issn.1007-0478.2022.04.006
文献标志码:
A
摘要:
目的 探讨烟雾病术后脑梗死的危险因素并建立列线图预测模型。方法 回顾性纳入502个大脑半球的临床资料并分为建模组(n=350)和验证组(n=152),对建模组进行单因素及多因素Logistic回归分析找出危险因素并建立列线图模型,分别采用Hosmer-Lemeshow拟合优度检验和ROC曲线评估列线图模型的校准度和区分度。结果 术后脑梗死的发生率为4.58%。多因素Logistic回归模型提示年龄≥50岁(OR=10.525)、近期短暂性脑缺血发作(Transient ischemic attack,TIA)(OR=3.271)、近期脑梗死直径≥1 cm(OR=4.206)是术后脑梗死的独立危险因素,后循环代偿(OR=0.260)是保护性因素。基于以上因素建立列线图,建模组和验证组的H-L检验提示模型校准度良好(χ2=31.962/32.674,P=0.964/0.956),列线图模型预测建模组和验证组的受试者工作特征曲线(Receiver operating characteristic curve,ROC)的曲线下面积(Area under curve,AUC)提示列线图模型区分度良好(AUC=0.888/0.845)。结论 年龄≥50岁、近期TIA史、近期脑梗死直径≥1cm是烟雾病术后脑梗死的危险因素,后循环良好代偿是保护性因素。建立的列线图模型可有效预测烟雾病患者术后发生脑梗死的风险。
Abstract:
ObjectiveTo explore the risk factors of postoperative cerebral infarction in ischemic Moyamoya disease(MMD)and develop a nomogram to predict the individual risk of cerebral infarction for postoperative patients with MMD.Methods The clinical data of 502 hemispheres were retrospectively included and they were divided into training set(n=350)and validation set(n=152). Univariate and multivariate logistic regression analysis were performed on the training set to find out the risk factors and a nomogram was constructed to identify cerebral infarction for postoperative patients with MMD. The Hosmer-Leme show test and receiver operating characteristic(ROC)curve were applied to assess the calibration and discrimination of this nomogram.Results The incidence of postoperative cerebral infarction was 4.58%. It showed that age≥50 years(OR=10.525), recent transient ischemic attack(TIA)(OR=3.271), recent cerebral infarction with diameter ≥1 cm(OR=4.206)were identified as independent risk factors via multivariate logistic regression model, and the good compensation for posterior circulation(OR=0.260)was a protective factor. Based on the above factors, the nomogram was established, which displayed excellent calibration(χ2=31.962/32.674, P=0.964/0.956)via the Hosmer-Leme show test of the training set and the validation set. The nomogram was found to have good discrimination [area under the curve(AUC)=0.888/0.845] via the area under the ROC curve.Conclusion Age≥50 years, recent TIA, and recent cerebral infarction with diameter ≥1 cm are risk factors for postoperative cerebral infarction in ischemic MMD, and the good compensation for posterior circulation is a protective factor. The nomogram could effectively predict the individual risk of cerebral infarction for postoperative patients with MMD.

参考文献/References:

[1] 烟雾病治疗中国专家共识编写组.烟雾病治疗中国专家共识[J].国际脑血管病杂志,2019,27(9): 645-650.
[2] Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives[J]. Lancet Neurol, 2008, 7(11): 1056-1066.
[3] Kazumata K, Itom M, Tokairin K, et al. The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review [J]. J Neurosurg, 2014, 121(2): 432-440.
[4] Abla AA, Gandhoke G, Clark JC, et al. Surgical outcomes for moyamoya angiopathy at barrow neurological institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass,adult direct superficial temporal artery-to-middle cerebral artery bypass,and pediatric bypass:154 revascularization surgeries in 140 affected hemispheres[J]. Neurosurgery, 2013, 73(3): 430-439.
[5] 赵亚妮,栾晓嵘,李海燕.175例烟雾病血管重建术后12例发生脑梗死的危险因素分析[J].山东大学学报(医学版),2019,57(10):93-100.
[6] Rupareliya C, Lui F. Moyamoya disease [M]. StatPearls. Treasure Island(FL), Stat Pearls Publishing Copyright �瘙 嚍 2021, StatPearls Publishing LLC. 2021.
[7] Ahn JS, Kwun BD, Park WH. Risk factors for Newly-Developed cerebral infarction after surgical revascularization for adults with moyamoya disease[J]. Cerebrovasc Dis, 2016, 42(1): 73.
[8] Qian Y, Huang B, Hu Z, et al. Analysis of factors related to cerebral infarction after direct bypass surgery in adults with moyamoya disease[J]. Cerebrovasc Dis, 2020, 49(1): 55-61.
[9] Bai Y, Liu ZS, Xiong JP, et al. Nomogram to predict overall survival after gallbladder cancer resection in China[J]. World Journal of Gastroenterology, 2018, 24(45): 5167-5178.
[10] Ye F, Wang T, Yin H, et al. Development and validation of a nomogram to predict the individual future stroke risk for adult patients with moyamoya disease: a multicenter retrospective cohort study in China[J]. Front Neurol, 2021, 12:69025.
[11] Yu J, Shi L, Guo Y, et al. Progress on complications of direct bypass for moyamoya disease[J]. Int J Med Sci, 2016, 13(8): 578-587.
[12] Araki Y, Yokoyama K, Uda K, et al. Postoperative stroke and neurological outcomes in the early phase after revascularization surgeries for moyamoya disease: an age-stratified comparative analysis[J]. Neurosurg Rev, 2021, 44(5): 2785-2795.
[13] Yu L, Ma L, Huang Z, et al. Revascularization surgery in patients with Ischemic-Type moyamoya disease: predictors for postoperative stroke and Long-Term outcomes[J]. World Neurosurg, 2019, 128: e582-e596.
[14] Hara S, Nariai T, Inaji M, et al. Imaging pattern and the mechanisms of postoperative infarction after indirect revascularization in patients with moyamoya disease[J]. World Neurosurg, 2021, 155: 510-e521.
[15] Kim TW, Seo BR, Kim JH, et al. Rapid progression of unilateral moyamoya disease[J]. J Korean Neurosurg Soc, 2011, 49(1): 65-67.
[16] Funaki T, Takahashi JC, Takagi Y, et al. Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications[J]. J Neurosurg, 2015, 122(2): 400-407.
[17] Zhai X, Mao L, Wang H, et al. Risk factors associated with neurologic deterioration after combined direct and indirect revascularization in patients with moyamoya disease on the East coast of China [J]. World Neurosurg, 2018, 118: e92-e98.
[18] Wei W, Chen X, Yu J, et al. Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis[J]. BMC Neurol, 2019, 19(1): 98.
[19] Lau AY, Wong EH, Wong A, et al. Significance of good collateral compensation in symptomatic intracranial atherosclerosis[J]. Cerebrovasc Dis, 2012, 33(6): 517-524.
[20] Wiegers EA, Mulder M, Jansen IH, et al. Clinical and imaging determinants of collateral status in patients with acute ischemic stroke in Mr CLEAN trial and registry[J]. Stroke, 2020, 51(5): 1493-1502.
[21] Liu ZW, Han C, Wang H, et al. Clinical characteristics and leptomeningeal collateral status in pediatric and adult patients with ischemic moyamoya disease[J]. CNS Neurosci Ther, 2020, 26(1): 14-20.
[22] Yu J, Zhang J, Chen J. The significance of natural anastomoses among intracranial vessels in moyamoya disease[J]. AJNR Am J Neuroradiol, 2020, 41(6): E41.
[23] Bonasia S, Ciccio G, Smajda S, et al. Angiographic analysis of natural anastomoses between the posterior and anterior cerebral arteries in moyamoya disease and syndrome[J]. AJNR Am J Neuroradiol, 2019, 40(12): 2066-2072.
[24] 施明明,陈心,魏伟,等.儿童缺血型烟雾病合并后循环病变与脑梗死的关系研究[J].中华神经外科杂志,2019,35(8):797-801.
[25] Ohkura A, Negoto T, Aoki T, et al. Stenotic changes of the posterior cerebral artery are a major contributing factor for cerebral infarction in moyamoya disease[J]. Surg Neurol Int, 2018, 9: 105.

更新日期/Last Update: 2022-09-10