中青年首发脑卒中患者急性应激障碍动态列线图模型的构建

目的 探讨首发中青年脑卒中患者急性应激障碍的影响因素并构建动态列线图模型，以帮助医护人员早期识别急性应激障碍。 方法 选取锦州医科大学附属第一医院298例首发脑卒中的中青年患者为研究对象，其中建模组208例和验证组90例。以生物-心理-社会医学模式为理论指导，收集15个备选因素。使用LASSO回归和多因素logistic回归分析筛选出急性应激障碍的危险因素。基于R-shiny构建动态列线图预测模型，采用Bootstrap法分别在建模组和验证组进行验证。 结果 298例首发中青年脑卒中患者中141例发生ASD，发生率（47.32%）。筛选出心理韧性、ADL、神经受损程度、吞咽障碍、偏瘫5个影响因素构建预测模型。建模组验证AUC为0.884，验证组验证AUC为0.879，2次验证Calibration曲线均与理想曲线接近。 结论 所构建的动态在线列线图模型预测效能良好，可为首发中青年脑卒中患者急性应激障碍筛查提供借鉴。

Construction of a dynamic nomogram model of acute stress disorder in first-episode young and middle-aged stroke patients

Objective To analyze the influencing factors of Acute Stress Disorder (ASD) in first-episode young and middle-aged stroke patients, and to construct a dynamic nomogram model, so as to facilitate early identification of ASD for medical staff. Methods A total of 298 first-episode young and middle-aged stroke patients in the first affiliated hospital, Jinzhou Medical University, were selected, then they were divided into a modeling group (n=208) and a validation group (n=90).Fifteen alternative factors were collected by using the bio-psycho-social medical model as a theoretical guide.LASSO regression and multinomial logistics regression were performed to screen risk factors of ASD.A dynamic nomogram model was constructed based on R-shiny, and the Bootstrap method was used for validation in the modeling group and the validation group. Results Totally 141 (47.32%) patients suffered from ASD.Five influencing factors of the Connor-Davidson Resilience Scale score, the Activities of Daily Living score, the National Institutes of Health Stroke Scale score, swallowing disorder, and hemiplegia were finally included through screening to construct the prediction model.The AUC in the modeling group was 0.884, and the AUC in the validation group was 0.879, and both of the validation calibration curves were close to the ideal curve. Conclusion This constructed dynamic nomogram model has good prediction perfor-mance, it provides a reference for ASD screening in first-episode young and middle-aged stroke patients.