列线图可预测首发缺血性脑卒中患者的复发

目的 探索影响首发缺血性脑卒中幸存者复发的危险因素，建立复发预测模型并使用列线图将预测结果可视化。方法 收 集2010年1月~2018年12月入住四川大学华西医院神经内科且符合纳入标准的首发缺血性脑卒中幸存者，共821例幸存者纳入研究，利用R软件对初始人群进行随机抽样，70%纳入训练集建立模型，30%纳入验证集。应用Cox比例风险回归模型对影响首发缺血性脑卒中幸存者复发的因素进行多因素分析，并使用R软件的rms包构造列线图，建立可视化的预测模型。利用C-index和校准曲线来评价模型的预测效果。结果 821例幸存者中，患者3年复发率为16.81%，5年复发率为19.98%；训练集经Cox回归模型多因素分析，年龄>65岁（HR=2.596，P=0.024）、年龄45~64岁（HR=2.510，P=0.006）、mRS评分≥3分（HR=2.284，P=0.004）、冠心病史（HR=1.353，P=0.034）是影响复发的危险因素；并由此建立列线图，3年（5年）复发预测模型的C-index为 0.640（0.671）。结论 首发缺血性脑卒中幸存者复发的影响因素是年龄、mRS评分和周围血管病史，列线图在首发缺血性脑卒中复发预测中有较高的区分度和预测力。

Development and validation of nomograms for predicting stroke recurrence after first-episode ischemic stroke

Objective To explore the risk factors for recurrence in first-episode ischemic stroke survivors and establish a model for predicting stroke recurrence using a nomogram. Methods We collected the data from a total of 821 first-episode ischemic stroke survivors admitted in the Department of Neurology, West China Hospital, Sichuan University from January, 2010 to December, 2018. R software was used for random sampling of the patients, and 70% of the patients were included in the training set to establish the prediction model and 30% were included in the validation set. Cox proportional risk regression model was used to analyze the factors affecting stroke recurrence, and R software rms package was used to construct the histogram and establish the visual prediction model. C-index and calibration curve were used to evaluate the performance of the model for predicting stroke occurrence. Results Among the 821 survivors, the recurrence rate was 16.81% at 3 years and 19.98% at 5 years. Multivariate analysis of the training set by Cox regression model showed that an age over 65 years (HR=2.596, P=0.024), an age of 45-64 years (HR=2.510, P=0.006), a mRS score beyond 3 (HR=2.284, P=0.004) and a history of coronary heart disease (HR=1.353, P=0.034) were all risk factors for stroke recurrence. The C-indexes of the nomogram for the 3-and 5-year relapse prediction model were 0.640 and 0.671, respectively. Conclusion Age, mRS score and peripheral vascular disease are the factors affecting stroke recurrence in first-episode ischemic stroke survivors, and the nomogram has a high discrimination and predictive power for predicting ischemic stroke recurrence.