分析老年急性脑梗死诱发胃肠损伤的风险因素并构建预测模型。

纳入阜阳市人民医院老年医学科2021年9月至2023年10月收治的159例老年急性脑梗死患者，按照3∶1比例，将159例患者分别纳入训练集（n=119）、验证集（n=40），按照训练集患者胃肠损伤发生情况，将患者分别纳入发生组、未发生组，对比2组患者临床资料，并使用Logistic多因素回归分析模型，总结诱发患者胃肠损伤的相关因素。基于风险因素建立Nomogram模型，使用受试者工作特征曲线（ROC）验证模型效能并绘制决策曲线分析（DCA）。

训练集119例患者中，53例发生胃肠损伤，发生率为44.54%，患者胃肠损伤以Ⅰ～Ⅱ级为主；验证集发生胃肠损伤18例，发生率为45.00%，组间比较差异无统计学意义（χ²=0.003，P=0.959）。Logistic多因素回归分析示，梗死部位为小脑、脑干或丘脑，血钠异常均为影响老年急性脑梗死诱发胃肠损伤的独立风险因素（P<0.05）。基于风险因素建立的列线图模型内部验证结果示，训练集、验证集AUC分别为0.881、0.867。Kolmogorov-Smimov拟合优度检验结果示模型校准度良好（χ²=3.879，R²=0.926，P>0.05）。DCA结果显示，在10%～88%阈值范围内，训练集、验证集决策曲线均位于All、None上方。

老年急性脑梗死患者胃肠损伤发生风险较高，与梗死部位、血钠水平异常有关，基于风险因素建立的列线图模型效能良好、净收益率较高，能够为胃肠损伤风险评估提供可靠参考。

To analyze the risk factors of gastrointestinal injury induced by acute cerebral infarction in the elderly and build a prediction model.

One hundred and fifty-nine elderly patients with acute cerebral infarction admitted to the Department of Geriatrics of Fuyang People's Hospital from September 2021 to October 2023 were included. According to the ratio of 3∶1, 159 patients were divided into a training set (n=119) and a validation set (n=40). According to the occurrence of gastrointestinal injury in the training set, the patients were divided into the occurrence group and the non-occurrence group. The clinical data of the two groups were compared, and Logistic multivariate regression was used to summarize the related factors inducing gastrointestinal injury. Based on the risk factors, the Nomogram model was established, and the efficiency of the model was verified by receiver operating characteristic (ROC) curve and the decision curve analysis (DCA) was drawn.

Among the 119 patients in the training set, 53 patients suffered from gastrointestinal injuries, the incidence rate was 44.54%, and the gastrointestinal injuries of patients were mainly Grade Ⅰ-Ⅱ. There were 18 cases of gastrointestinal injury in the verification group, the incidence rate was 45.00%, and there was no statistically significant difference between the two groups (χ²=0.003, P=0.959). Logistic multivariate regression analysis showed that the infarction site was cerebellum, brain stem or thalamus and abnormal blood sodium were independent risk factors for gastrointestinal injury induced by acute cerebral infarction in the elderly (P<0.05). The internal verification results of Nomogram model based on risk factors showed that the AUC of training set and verification set were 0.881 and 0.867, respectively. Kolmogorov-Smimov goodness-of-fit test results showed that the calibration of the model was good (χ²=3.879, R²=0.926, P>0.05). DCA results showed that the decision curves of training set and test set were above All and None in the threshold range of 10%-88%.

The risk of gastrointestinal injury in elderly patients with acute cerebral infarction is high, which is related to the location of infarction, blood sodium level abnormal. The Nomogram model based on risk factors has good efficiency and high net yield, which can provide reliable reference for risk assessment of gastrointestinal injury.