2024 年第 9 期 第 0 卷

缺血性脑卒中患者介入术后颈动脉血管再狭窄的危险因素分析

Analysis of risk factors for carotid artery restenosis after interventional therapy in patients with ischemic stroke

作者：徐丹1杨占辉1王鹏1张爱军2季辉3

英文作者：Xu Dan1 Yang Zhanhui1 Wang Peng1 Zhang Aijun2 Ji Hui3

单位：1河北省衡水市人民医院介入科，衡水053000；2河北省衡水市第二人民医院药剂科，衡水053000；3河北省衡水市人民医院神经内科，衡水053000

英文单位：1Department of Intervention Hengshui People′s Hospital Hebei Province Hengshui 053000 China; 2Department of Pharmacy the Second People′s Hospital of Hengshui Hebei Province Hengshui 053000 China; 3Department of Neurology Hengshui People′s Hospital Hebei Province Hengshui 053000 China

关键词：缺血性脑卒中；血管内介入术；颈动脉血管再狭窄；危险因素

英文关键词：

• 摘要：

• 目的 分析缺血性脑卒中患者介入术后颈动脉血管再狭窄的危险因素。方法 收集河北省衡水市人民医院2020年12月至2022年12月接受血管内介入治疗的110例缺血性脑卒中患者的临床资料行回顾性分析。所有患者进行了为期1年的随访，根据复查颈动脉超声的结果将其分为无再狭窄组（42例）和再狭窄组（68例）。通过Logistic回归方法分析缺血性脑卒中患者血管内介入术后颈动脉血管再狭窄的危险因素，通过R软件构建列线图预测模型，以Bootstrap法进行内部验证，以Hosmer-Lemeshow进行拟合优度检验，采用受试者工作特征（ROC）曲线评价列线图的预测效能。结果 再狭窄组吸烟史、高同型半胱氨酸血症（HHcy）、术后颈总动脉近端管径<6.8 mm、术后颈内动脉近端管径<4.8 mm、术后血清C反应蛋白（CRP）>10 mg/L比例均高于无再狭窄组（均P＜0.05）。单因素Logistic回归分析结果显示，吸烟史、HHcy、术后颈总动脉近端管径小、术后颈内动脉近端管径小、术后血清CRP高均为血管内介入术后颈动脉血管再狭窄的危险因素（比值比=4 158.246、31.064、140.768、295.064和8 286.344，均P＜0.05）。基于血管内介入术后颈动脉血管再狭窄的列线图预测模型以及校准曲线预测血管内介入术后颈动脉血管再狭窄发生率与实际发生率的一致性较好，一致性指数为0.913。ROC曲线分析结果显示曲线下面积为0.913（95%置信区间：0.821～0.942），意味着该预测模型判别能力、预测价值高。结论 缺血性脑卒中患者血管内介入术后颈动脉血管再狭窄的发生与吸烟史、HHcy、术后颈总动脉近端管径小、术后颈内动脉近端管径小、术后血清CRP高有关，应当引起临床重视。

• Objective To analyze the risk factors of carotid artery restenosis after interventional therapy in patients with ischemic stroke. Methods The clinical data of 110 patients with ischemic stroke who underwent endovascular interventional therapy in Hengshui People′s Hospital, Hebei Province from December 2020 to December 2022 were collected and retrospectively analyzed. All patients were followed up for 1 year. According to the results of re-examination of carotid ultrasound, the patients were divided into the non-restenosis group (42 cases) and the restenosis group (68 cases). Logistic regression was used to analyze the risk factors of carotid artery restenosis after endovascular intervention in patients with ischemic stroke. The nomogram prediction model was constructed by R software, internal validation was performed by Bootstrap method, goodness of fit test was performed by Hosmer-Lemeshow test, and the predictive efficacy of the nomogram was evaluated by receiver operating characteristic (ROC) curve. Results The proportion of smoking history, hyperhomocysteinemia (HHcy), postoperative proximal carotid artery diameter<6.8 mm, postoperative proximal internal carotid artery diameter<4.8 mm, and postoperative serum C-reactive protein(CRP)>10 mg/L in the restenosis group were higher than those in the non-restenosis group(all P<0.05). The results of univariate Logistic regression analysis showed that smoking history, HHcy, small postoperative proximal diameter of the common carotid artery, small postoperative proximal diameter of the internal carotid artery, and high postoperative serum CRP were all risk factors for carotid artery restenosis after intravascular intervention (odds ratios=4 158.246, 31.064, 140.768, 295.064, and 8 286.344, all P<0.05). The nomogram prediction model and calibration curve based on the incidence of carotid restenosis after endovascular intervention had a good consistency with the actual incidence, and the concordance index was 0.913. The ROC curve analysis showed that the area under the curve was 0.913 (95% confidence interval: 0.821-0.942), indicating that the prediction model had high discrimination power and predictive value. Conclusion The occurrence of carotid artery restenosis after endovascular intervention in patients with ischemic stroke is related to smoking history, HHcy, small postoperative proximal diameter of common carotid artery, small postoperative proximal diameter of internal carotid artery, and high postoperative serum CRP, which should be paid attention to in clinical practice.