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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 213 -217. doi: 10.3877/cma.j.issn.2095-2015.2024.03.005

论著

老年急性脑梗死诱发胃肠损伤的风险因素分析及模型构建
赵倩1, 刘文超1,†(), 李玺琳1, 章邱东1   
  1. 1. 236000　安徽省，阜阳市人民医院老年医学科
  • 收稿日期:2023-12-25 出版日期:2024-06-01
  • 通信作者: 刘文超

Risk factors analysis and model construction of gastrointestinal injury induced by acute cerebral infarction in the elderly

Qian Zhao1, Wenchao Liu1,†(), Xilin Li1, Qiudong Zhang1   

  1. 1. Department of Geriatrics, Fuyang People's Hospital, Anhui Province, Fuyang 236000, China
  • Received:2023-12-25 Published:2024-06-01
  • Corresponding author: Wenchao Liu
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赵倩, 刘文超, 李玺琳, 章邱东. 老年急性脑梗死诱发胃肠损伤的风险因素分析及模型构建[J]. 中华消化病与影像杂志(电子版), 2024, 14(03): 213-217.

Qian Zhao, Wenchao Liu, Xilin Li, Qiudong Zhang. Risk factors analysis and model construction of gastrointestinal injury induced by acute cerebral infarction in the elderly[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(03): 213-217.

目的

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。

方法

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）。

结果

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。

结论

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。

关键词: 急性脑梗死, 老年人, 胃肠损伤, 风险因素, 预测模型
Objective

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

Methods

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.

Results

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%.

Conclusion

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.

Key words: Acute cerebral infarction, The elderly, Gastrointestinal injury, Risk factors, Prediction model
表1 训练集发生组、未发生组临床资料比较[例（%）]
组别 例数 性别 年龄 梗死部位
男 女 60~74岁 ≥75岁 基底节区 脑叶 小脑 脑干 丘脑
发生组 53 37(69.81) 16(30.19) 21(39.62) 32(60.38) 32(60.38) 3(5.66) 7(13.21) 5(9.43) 6(11.32)
未发生组 66 17(25.76) 49(74.24) 27(40.91) 39(59.09) 50(75.76) 6(9.09) 4(6.06) 3(4.55) 3(4.55)
χ2值   23.016 0.02 6.842
P值   <0.001 0.887 0.033
组别 例数 高血压 糖尿病 冠心病 血钾
无 有 无 有 无 有 正常 异常
发生组 53 9(16.98) 44(83.02) 28(52.83) 24(45.28) 35(66.03) 18(33.96) 20(37.74) 33(62.26)
未发生组 66 10(15.15) 56(84.85) 37(56.06) 30(45.45) 40(60.60) 26(39.39) 55(83.33) 11(16.67)
χ2值   0.073 1.006 0.057 26.226
P值   0.787 0.316 0.812 <0.001
组别 例数 血钠 血钙 肝肾功能 凝血功能
正常 异常 正常 异常 正常 异常 正常 异常
发生组 53 24(45.28) 29(54.72) 29(54.72) 24(45.28) 35(66.04) 18(33.96) 29(54.72) 24(45.28)
未发生组 66 60(90.91) 6(9.09) 17(25.76) 49(74.24) 46(69.7) 20(30.3) 17(25.76) 49(74.24)
χ2值   29.474 10.396 0.181 10.396
P值   <0.001 0.001 0.67 0.001
表2 影响老年急性脑梗死诱发胃肠损伤的多因素回归分析结果
影响因素 β SE(β) Wald χ2值 P值 OR 95% CI
男性 0.252 0.236 1.140 0.714 1.287 0.810~2.043
梗死部位为小脑、脑干或丘脑 2.126 0.535 15.791 0.005 8.381 2.937~23.917
血钾异常 0.597 0.449 1.768 0.141 1.817 0.753~4.380
血钠异常 0.962 0.312 9.507 0.009 2.617 1.420~4.824
血钙异常 0.225 0.183 1.512 0.197 1.252 0.875~1.793
凝血功能异常 0.358 0.406 0.778 0.529 1.430 0.645~3.170
图1 老年急性脑梗死诱发胃肠损伤的预测列线图
表3 模型区分度评价及内部验证
集合 约登指数 灵敏度 特异性 阳性预测值 阴性预测值 AUC 95% CI
训练集 0.871 0.826 0.853 0.835 0.851 0.881 0.864~0.905
验证集 0.836 0.855 0.876 0.833 0.862 0.867 0.858~0.883
图2 老年急性脑梗死诱发胃肠损伤预测列线图的决策曲线分析结果
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