高血压脑出血患者并发脑水肿风险列线图预测模型^*

Risk Nomogram Prediction Model for Cerebral Edema in Patients With Hypertensive Intracerebral Hemorrhage

摘要

目的 建立高血压脑出血（HICH）患者并发脑水肿的风险预测模型并验证。方法 回顾性选取2020年1月–2025年3月320例HICH患者，随后依照7∶3分为训练集（n=224），验证集（n=96）。根据患者是否发生脑水肿，将训练集分为脑水肿组（n=71）和非脑水肿组（n=153），将验证集分为脑水肿组（n=31）和非脑水肿组（n=65）。LASSO回归筛选变量后进行logistic多因素分析，并建立列线图预测模型，采用受试者工作特征（ROC）曲线和校准曲线对模型进行验证。结果 训练集有71例（31.70%）、验证集有31例（32.29%）患者发生脑水肿。脑水肿组与非脑水肿组患者年龄、血肿体积、格拉斯哥昏迷量表评分（GCS）、美国国立卫生研究院卒中量表（NIHSS）、血清基质金属蛋白酶-9（MMP-9）、血管生成素样蛋白2（ANGPTL2）、血小板反应蛋白-1（TSP-1）水平差异存在统计学意义（P<0.05）；多因素logistic分析显示：血肿体积〔比值比（OR）=1.227，95% 可信区间（CI）：1.115～1.351〕、GCS（OR=0.700，95%CI：0.569～0.862）、NIHSS（OR=1.176，95%CI：1.030～1.342）、MMP-9（OR=1.017，95%CI：1.009～1.026）、ANGPTL2（OR=3.759，95%CI：1.784～7.919）、TSP-1（OR=1.097，95%CI：1.046～1.149）是HICH患者并发脑水肿的影响因素（P<0.05）；ROC曲线分析显示，训练集曲线下面积（AUC）为0.930（95%CI：0.886～0.962），验证集的AUC为0.952（95%CI：0.915～0.990）；校准曲线显示，训练集与验证集的预测曲线与标准曲线基本拟合。结论 血肿体积、GCS、NIHSS、血清MMP-9、ANGPTL2、TSP-1水平是HICH患者并发脑水肿的影响因素，基于上述因素构建的列线图模型具有一定预测效能。

Abstract

Objective To establish and validate a risk prediction model for cerebral edema in patients with hypertensive intracerebral hemorrhage (HICH). Methods A total of 320 HICH patients from January 2020 to March 2025 were retrospectively selected and divided into a training set (n = 224) and a validation set (n = 96) at a ratio of 7∶3. Based on the occurrence of cerebral edema, the training set was divided into a cerebral edema group (n = 71) and a non-cerebral edema group (n = 153), and the validation set was divided into a cerebral edema group (n = 31) and a non-cerebral edema group (n = 65). LASSO regression was used to screen variables, followed by multivariate logistic analysis, and a nomogram prediction model was established. The model was validated using the receiver operating characteristic (ROC) curve analysis and calibration curve. Results There were 71 cases (31.70%) in the training set and 31 cases (32.29%) in the validation set with cerebral edema. Statistically significant differences were found in age, hematoma volume, Glasgow Coma Scale (GCS) score, National Institutes of Health Stroke Scale (NIHSS), serum matrix metalloproteinase-9 (MMP-9), angiopoietin-like protein 2 (ANGPTL2), and thrombospondin-1 (TSP-1) levels between the cerebral edema and non-cerebral edema groups (P < 0.05). Multivariate logistic analysis showed that hematoma volume (odds ratio [OR] = 1.227, 95% confidence interval [CI]: 1.115-1.351), GCS (OR = 0.700, 95% CI: 0.569-0.862), NIHSS (OR = 1.176, 95% CI: 1.030-1.342), MMP-9 (OR = 1.017, 95% CI: 1.009-1.026), ANGPTL2 (OR = 3.759, 95% CI: 1.784-7.919), and TSP-1 (OR = 1.097, 95% CI: 1.046-1.149) were influencing factors for cerebral edema in HICH patients ( P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of the training set was 0.930 (95% CI: 0.886-0.962), and that of the validation set was 0.952 (95% CI: 0.915-0.990). The calibration curve showed that the prediction curves of the training and validation sets were consistent with the standard curve. Conclusion Hematoma volume, GCS, NIHSS, serum MMP-9, ANGPTL2, and TSP-1 levels are influencing factors for cerebral edema in HICH patients, and the nomogram model constructed based on these factors has demonstrated efficacy.

关键词

高血压脑出血 / 脑水肿 / 列线图

Key words

Hypertensive cerebral hemorrhage / Cerebral edema / Nomogram

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基金资助

*安徽省重点研究与开发计划项目(2022e07020029)