| 摘要: |
| 目的 探讨影响中青年脑梗死患者预后的危险因素，并建立临床预后预测模型，为预后判断和制订个体化治疗方案提供参考。方法 纳入2018年1月1日至2020年1月1日在复旦大学附属中山医院吴淞医院住院治疗、年龄为18~60岁的中青年脑梗死患者294例。收集患者年龄、性别、既往史、美国国立卫生研究院卒中量表（NIHSS）评分、血液学指标等基线资料，检测环指蛋白213（RNF213）基因（rs112735431位点）、组蛋白去乙酰化酶9（HDAC9）基因（rs2107595、rs2240419、rs2389995位点）和亚甲基四氢叶酸还原酶（MTHFR）基因（C677T位点）的基因多态性。根据随访1年时的临床结局，294例患者被分为病情未发展组（177例，60.20%）、病情发展组（117例，39.80%），比较两组患者上述指标的差异。将数据样本按7：3的比例划分为训练集和测试集，以上述指标为自变量，随访1年时的临床结局为因变量，利用训练集数据进行logistic回归分析获得影响预后的危险因素并建立预后预测模型，利用训练集和测试集的数据进行ROC曲线分析以评估模型的价值。结果 病情发展组患者的NIHSS评分及血肌酐、总胆红素、同型半胱氨酸水平均高于病情未发展组，差异均有统计学意义（P均<0.05）；病情发展组与病情未发展组的MTHFR（C677T）基因多态性分布不同，差异有统计学意义（P<0.01）。logistic回归分析结果显示，NIHSS评分每增加1分，病情发展的风险增加76.8%（OR=1.768，95% CI 1.479~2.112）；MTHFR（C677T）基因TT型患者病情发展的风险是CC型的4.128倍（OR=4.128，95% CI 1.497~11.383）；患有高血压的患者病情发展的风险是未患有高血压患者的3.421倍（OR=3.421，95% CI 1.353~8.645）。训练集ROC曲线的AUC值为0.856（95% CI 0.806~0.906），测试集ROC曲线的AUC值为0.847（95% CI 0.756~0.937），表明模型的预测能力良好。结论 NIHSS评分、MTHFR（C677T）基因多态性、高血压是中青年脑梗死患者病情发展的危险因素，基于NIHSS评分、MTHFR（C677T）基因多态性、高血压3个自变量建立的预后预测模型有助于判断中青年脑梗死患者的预后。 |
| 关键词: 中年人 青年人 大脑梗死 危险因素 单核苷酸多态性 预后 |
| DOI：10.16781/j.0258-879x.2021.10.1132 |
| 投稿时间：2021-04-01修订日期：2021-06-04 |
| 基金项目:上海市宝山区科学技术委员会科技创新专项（18-E-3）. |
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| Prognostic factor analysis and prognostic model establishment for young and middle-aged patients with cerebral infarction |
| WANG Bo1△,XIE Li1△,SHEN Tao1,MAO Lei1,YANG Peng-fei2,LIU Tuan-jie1* |
(1. Department of Neurology, Wusong Branch of Zhongshan Hospital, Fudan University, Shanghai 200940, China;
2. Stroke Center, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the risk factors affecting the prognosis of young and middle-aged patients with cerebral infarction, and establish a clinical prognostic prediction model for its prognosis and individualized treatment. Methods A total of 294 young and middle-aged patients with cerebral infarction hospitalized in Wusong Branch of Zhongshan Hospital, Fudan University from Jan. 1, 2018 to Jan. 1, 2020 were included. The baseline data such as age, gender, past history, National Institutes of Health stroke scale (NIHSS) score and blood indexes were collected. The gene polymorphisms of ring finger protein 213 (RNF213) gene (rs112735431), histone deacetylase 9 (HDAC9) gene (rs2107595, rs2240419, rs2389995) and methylenetetrahydrofolate reductase (MTHFR) gene (C677T) were detected. According to the clinical outcomes at 1-year follow-up, 294 patients were divided into non-progression group (177 cases, 60.20%) and progression group (117 cases, 39.80%). The above indexes were compared between the 2 groups. The patients were divided into training set and test set by a ratio of 7:3. With the above indexes as independent variables and the clinical outcome at 1-year follow-up as dependent variable, the data of the training set were used for logistic regression analysis to identify the risk factors of prognosis and to establish a prognostic prediction model. The data of the training set and test set were used for receiver operating characteristic (ROC) curve analysis to evaluate the value of the model. Results The NIHSS score and levels of serum creatinine, total bilirubin and homocysteine in the progression group were significantly higher than those in the non-progression group (all P<0.05); and the distribution of MTHFR (C677T) gene polymorphism was different between the 2 groups (P<0.01). Logistic regression analysis showed that the risk of disease progression increased by 76.8% with every 1 point increment of NIHSS score (odds ratio[OR]=1.768, 95% confidence interval[CI] 1.479-2.112); the risk of disease progression in patients with TT genotype of MTHFR (C677T) gene was 4.128 times higher than that in patients with CC genotype (OR=4.128, 95% CI 1.497-11.383); and the risk of disease progression in patients with hypertension was 3.421 times higher than that in patients without hypertension (OR=3.421, 95% CI 1.353-8.645). The area under curve (AUC) of ROC curve in the training set was 0.856 (95% CI 0.806-0.906), and that in the test set was 0.847 (95% CI 0.756-0.937), indicating good prediction ability of the model. Conclusion NIHSS score, MTHFR (C677T) gene polymorphism and hypertension are risk factors for the progression of cerebral infarction in young and middle-aged patients. The clinical prognostic model based on NIHSS score, MTHFR (C677T) gene polymorphism and hypertension is helpful in evaluating prognosis of young and middle-aged patients with cerebral infarction. |
| Key words: middle-aged young adult cerebral infarction risk factors single nucleotide polymorphism prognosis |
