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脑出血手术后运动恐惧患者风险预测模型的构建与验证

Construction and verification of a risk prediction model for patients with kinesophobia after cerebral hemorrhage surgery.

作者信息

Huang Yan, Huang Ya-Ting, Yuan Jie, WuYang Zhi-Yu, Zhang Xue, Yu Chuan-Qing

机构信息

Department of Neurosurgery, The First Affiliated Hospital of Anhui University of Science and Technology(First People's Hospital of Huainan), Huainan, Anhui, 232007, China.

Department of Interventional Catheterization Laboratory, The First Affiliated Hospital of Anhui University of Science and Technology(First People's Hospital of Huainan), Huainan, Anhui, 232007, China.

出版信息

BMC Neurol. 2025 Jul 12;25(1):289. doi: 10.1186/s12883-025-04296-0.

Abstract

OBJECTIVE

To establish a risk prediction model of kinesophobia in patients after cerebral hemorrhage surgery and verify its effect.

METHODS

A total of 218 patients after cerebral hemorrhage surgery were selected, and the differences in clinical data between kinesophobia patients and non-kinesophobia patients were analyzed. Using 20 indexes as independent variables, the characteristic variables were screened by LASSO regression, and then multivariate Logistic regression analysis was carried out. Based on the results, the nomogram prediction model was constructed, and the model was verified from the aspects of clinical applicability, discrimination, and calibration.

RESULTS

Significant differences were found in age, electronic health literacy score, depression score, NIHSS score, VAS pain score, intraoperative blood loss, and anxiety score between patients with phobia and non-phobia (P < 0.05). 12 characteristic variables were selected by LASSO regression. Multivariate Logistic regression analysis showed that age, NIHSS score, VAS pain score and depression score were independent risk factors for the occurrence of kinesophobia after cerebral hemorrhage surgery (OR > 1 and P < 0.05), and electronic health literacy score was an independent protective factor (OR < 1 and P < 0.05). Based on age, NIHSS score, VAS pain score, e-health literacy score, and depression score, a nomogram prediction model was constructed. The DCA curve shows that the model has the highest clinical net benefit when the threshold probability is between 0.14 and 0.99, indicating good clinical applicability. The area under the ROC curve (AUC) is 0.836(95% CI: 0.782-0.890), which indicates good discrimination. Spiegelhalter's z test and the calibration curve show that the calibration degree is good, and the C statistic after Bootstrap self-sampling internal verification is 0.820 (95% CI: 0.772-0.877), indicating that the prediction is robust.

CONCLUSION

The nomogram prediction model of the risk of kinesophobia after cerebral hemorrhage based on multivariate regression analysis has a good prediction effect, which can provide reference for the clinical prevention of kinesophobia after cerebral hemorrhage.

摘要

目的

建立脑出血手术后患者运动恐惧的风险预测模型并验证其效果。

方法

选取218例脑出血手术后患者,分析运动恐惧患者与非运动恐惧患者临床资料的差异。以20项指标为自变量,通过LASSO回归筛选特征变量,然后进行多因素Logistic回归分析。基于结果构建列线图预测模型,并从临床适用性、区分度和校准度方面对模型进行验证。

结果

恐惧患者与非恐惧患者在年龄、电子健康素养得分、抑郁得分、美国国立卫生研究院卒中量表(NIHSS)得分、视觉模拟评分法(VAS)疼痛评分、术中失血量及焦虑得分方面存在显著差异(P<0.05)。通过LASSO回归选取了12个特征变量。多因素Logistic回归分析显示,年龄、NIHSS得分、VAS疼痛评分及抑郁得分是脑出血手术后发生运动恐惧的独立危险因素(OR>1且P<0.05),电子健康素养得分是独立保护因素(OR<1且P<0.05)。基于年龄、NIHSS得分、VAS疼痛评分、电子健康素养得分及抑郁得分构建了列线图预测模型。决策曲线分析(DCA)曲线显示,当阈值概率在0.14至0.99之间时,该模型具有最高的临床净效益,表明临床适用性良好。受试者工作特征曲线(ROC)下面积(AUC)为0.836(95%可信区间:0.782 - 0.890),表明区分度良好。Spiegelhalter's z检验和校准曲线显示校准度良好,自抽样内部验证后的C统计量为0.820(95%可信区间:0.772 - 0.877),表明预测稳健。

结论

基于多因素回归分析的脑出血后运动恐惧风险列线图预测模型具有良好的预测效果,可为脑出血后运动恐惧的临床预防提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/559b/12255136/6959a355f2fe/12883_2025_4296_Fig1_HTML.jpg

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