Chinese Journal of Tissue Engineering Research ›› 2025, Vol. 29 ›› Issue (35): 7544-7551.doi: 10.12307/2025.955
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Yang Bo, Pan Xinfang, Chang Liuhui, Ni Yong
Received:
2024-10-22
Accepted:
2024-12-23
Online:
2025-12-18
Published:
2025-04-30
Contact:
Ni Yong, MD, Associate chief physician, Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
About author:
Yang Bo, MD, Attending physician, Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Supported by:
CLC Number:
Yang Bo, Pan Xinfang, Chang Liuhui, Ni Yong. Correlation of echocardiographic parameters with disability at 3 months after acute ischemic stroke[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(35): 7544-7551.
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2.3 无残疾组与残疾组患者基线资料比较 299例急性缺血性脑卒中患者年龄中位数为67岁,女性100例,男性199例,体质量指数中位数为24.0 kg/m2,入院NIHSS评分中位数为2分,发病到入院时间中位数为16 h;入院时溶栓者35例,取栓者(包括桥接治疗)5例;既往吸烟者96例,饮酒者47例;合并高血压病者216例,口服改善心功能药物者77例,糖尿病者103例,房颤者30例,冠心病者23例,有脑卒中史者61例(20.4%);TOAST分型中大动脉粥样硬化型125例,心源性栓塞型55例,小动脉闭塞型92例,其他明确病因型14例,不明原因型13例;OCSP分型中完全前循环梗死20例,部分前循环梗死95例,后循环梗死74例,腔隙性梗死110例。 发病3个月时残疾患者有92例(30.8%),无残疾者207例(69.2%)。比较两组的基线特征发现,两组人口统计学资料(年龄、性别)、体质量指数、发病到入院时间、特殊治疗方式(是否行静脉溶栓、机械取栓)、个人史(吸烟、饮酒史)、既往病史及用药史(高血压病、改善心功能药物服用情况、糖尿病、房颤、冠心病、脑卒中史)比较差异均无显著性意义(P > 0.05),残疾组患者入院NIHSS评分更高(4.0分vs. 1.0分,P < 0.001),TOAST分型中小动脉闭塞型占比低(17.4% vs. 36.7%,P=0.005),OCSP分型中后循环梗死(23.9% vs. 25.1%)和腔隙性梗死(16.3% vs. 46.9%)占比更低(P < 0.001),见表2。"
2.4.3 缺血性脑卒中患者发病3个月时功能残疾的ROC曲线分析 根据表2-4结果,脑卒中患者发病3个月时残疾的独立影响因素为左室射血分数、入院NIHSS评分、OCSP分型,混杂因素为TOAST分型。将入院NIHSS评分、OCSP分型纳入模型1,模型1加入左室射血分数作为模型2,模型2加入混杂因素作为模型3,使用ROC曲线分析3个模型对患者发病3个月时残疾的预测效果。 模型1、模型2、模型3的ROC曲线下面积AUC分别为0.769,0.806,0.824,AUC值的提升提示了左室射血分数在脑卒中患者预后评估中的重要性,模型2与模型3的ROC曲线下面积AUC变化虽小,但进一步说明校正混杂因素后左室射血分数对预测模型的独立贡献仍然存在且作用稳定,见图4,表5。表明在实际临床工作中,"
通过常规超声心动图测量左室射血分数,不仅可用于判断心功能状态,还可为脑卒中患者的个体化风险分层提供可靠依据。随着左室射血分数的加入,模型的敏感度和特异度均有所优化,这提示结合左室射血分数的预测模型能够更精准地筛选出高风险患者,同时减少低风险患者的误分类,从而在临床实践中具备更高的适用性。因此,模型预测效果的逐步提升表明,在以入院NIHSS评分和OCSP分型为基础的预测模型中加入左室射血分数,不仅可以改善模型的预测性能,还能通过敏感度和特异度的优化实现更高效的风险分层。未来应进一步探讨如何将左室射血分数与其他心脏功能指标联合应用以构建更全面的脑卒中预后评估工具,从而指导个体化治疗决策。 2.4.4 不同左室射血分数水平缺血性脑卒中患者发病3个月时功能残疾率的比较 根据左室射血分数与脑卒中患者发病3个月时残疾的ROC曲线,得到左室射血分数的最佳切点为60.25%,据此将299例患者分为低左室射血分数组(左室射血分数≤60.25%)和高左室射血分数组(左室射血分数> 60.25%),比较两组间发病3个月残疾率并绘制百分比堆积条形图,低左室射血分数组患者发病3个月时的残疾率高于高左室射血分数组(44% vs. 26%,P=0.002),见图5。"
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