预测成人烟雾病血运重建术后新发脑梗死的列线图及其验证：一项回顾性研究
A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study.
作者信息
Wang Zhen, Yu Jiacheng, Zhang Yu, Ruan Jiaping, Liu Xiaojie, Ma Sijia, Xie Jun, Wu Mimi, Bo Jinhua, Sun Yu'e
机构信息
Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Front Neurol. 2025 Jan 24;16:1537755. doi: 10.3389/fneur.2025.1537755. eCollection 2025.
BACKGROUND
The new-onset cerebral infarction is frequent after revascularization of moyamoya disease (MMD) in adults, serving as a major public health issue worldwide. The present study aims to construct a nomogram to predict postoperative new-onset cerebral infarction (POCI) after revascularization of adult MMD.
MATERIALS AND METHODS
Clinical data of 653 cases of adult MMD treated with revascularization were retrospectively analyzed. They were randomly divided into a training set ( = 457) and a validation set ( = 196) at a ratio of 7:3. Based on the risk factors of POCI after revascularization of adult MMD identified by logistic regression analysis and the corresponding regression coefficients, a nomogram was constructed. Its performance to predict POCI after revascularization of adult MMD was validated by calculating the area under the curve (AUC) and the decision curve analysis.
RESULTS
Univariate and multivariate logistic regression analyses showed that preoperative cerebral infarction (OR 2.548, 95% CI 1.357-4.787; = 0.004), posterior cerebral artery anomalies (OR 2.106, 95% CI 1.157-3.834; = 0.015), post-transit arterial development (OR 2.983, 95% CI 1.336-6.661; = 0.008), pre-anesthesia mean arterial pressure > 102.830 mmHg (OR 3.329, 95% CI 1.938-5.721; < 0.001), total operating time > 212.500 min (OR 2.256, 95% CI 1.239-4.140; = 0.008), preoperative fibrinogen level > 2.750 g/L (OR 1.852, 95% CI 1.072-3.200; = 0.027), and mean corpuscular hemoglobin concentration (OR 1.021, 95% CI 1.001-1.040; = 0.038) were independent risk factors of POCI after revascularization of adult MMD. The AUC was 0.772 (95% CI 0.714-0.772) in the training set, and 0.718 (95% CI 0.603-0.833) in the validation set.
CONCLUSION
Collectively, the newly established nomogram effectively and intuitively predicts the POCI after revascularization of adult MMD.
CLINICAL TRIAL REGISTRATION
www.chictr.org, identifier ChiCTR2400087946.
背景
烟雾病（MMD）成人患者血运重建术后新发脑梗死较为常见，这是一个全球性的重大公共卫生问题。本研究旨在构建一种列线图，以预测成人烟雾病血运重建术后的术后新发脑梗死（POCI）。
材料与方法
回顾性分析653例接受血运重建治疗的成人烟雾病患者的临床资料。按照7:3的比例将他们随机分为训练集（n = 457）和验证集（n = 196）。基于逻辑回归分析确定的成人烟雾病血运重建术后POCI的危险因素及相应回归系数，构建列线图。通过计算曲线下面积（AUC）和决策曲线分析来验证其预测成人烟雾病血运重建术后POCI的性能。
结果
单因素和多因素逻辑回归分析显示，术前脑梗死（OR 2.548，95%CI 1.357 - 4.787；P = 0.004）、大脑后动脉异常（OR 2.106，95%CI 1.157 - 3.834；P = 0.015）、术后过渡动脉发育（OR 2.983，95%CI 1.336 - 6.661；P = 0.008）、麻醉前平均动脉压>102.830 mmHg（OR 3.329，95%CI 1.938 - 5.721；P < 0.001）、总手术时间>212.500 min（OR 2.256，95%CI 1.239 - 4.140；P = 0.008）、术前纤维蛋白原水平>2.750 g/L（OR 1.852，95%CI 1.072 - 3.200；P = 0.027）以及平均红细胞血红蛋白浓度（OR 1.021，95%CI 1.001 - 1.040；P = 0.038）是成人烟雾病血运重建术后POCI的独立危险因素。训练集中AUC为0.772（95%CI 0.714 - 0.772），验证集中AUC为0.718（95%CI 0.603 - 0.833）。
结论
总体而言，新建立的列线图能有效且直观地预测成人烟雾病血运重建术后的POCI。
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