兰州大学机构库 >第二临床医学院
基于临床实验室指标评估预警缺血性卒中
Alternative TitleEvaluation and early warning of ischemic stroke based on clinical laboratory indicators
管沛文
Subtype硕士
Thesis Advisor尤崇革
2021-05-25
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name医学硕士
Degree Discipline临床检验诊断学
Keyword缺血性卒中 实验室检查 危险因素
Abstract目的 通过回顾性分析挖掘临床实验室指标水平与缺血性卒中(Ischemic stroke,IS)的相关性,并建立临床模型用于评估预警IS的发生发展。 方法 收集兰州大学第二医院神经内科于2019年06月至2020年12月收治的300例IS患者的血液样本、人口学信息、神经内科评分以及影像学资料,通过电话咨询的形式对患者的临床信息进行确定及补充。收集并录入血常规、生化全项、凝血、甲状腺功能等84项临床实验室指标中已检测项目,缺失项目和患者血清Lp-PLA2、CRP、NT-proBNP、IL-6、PCT、FFA水平经补充检测后录入。依据IS患者梗死灶面积、神经功能损伤程度、颈动脉斑块、颅内大动脉狭窄等资料将数据分层,分别通过组间差异分析、共线性检验、非条件二元logistic回归以及ROC曲线确定独立影响因素并建立联合预警模型,R软件中ROC曲线、模型校准图和列线图用于验证联合预警模型的评估预警效能。 结果 1)Cys C、CO2、PHOS、IBIL、ApoAⅠ/ApoB和文化程度是IS患者脑梗死面积的独立影响因子;包括患者文化程度、Cys C、CO2、PHOS、D dimer、ApoAⅠ/ApoB、ApoB水平的联合预警模型对非腔隙性脑梗死诊断效能较好。2)NE/HDL-C、ApoAⅠ/ApoB和文化程度是IS患者神经功能损伤的独立影响因子;包括患者文化程度、FT3、NE/HDL-C、ApoAⅠ/ApoB水平的联合预警模型对中重度神经功能损伤诊断效能较好。3)Cys C、FIB和年龄是IS患者颈动脉斑块的独立危险因子;包括患者年龄、Glu、Cys C和FIB水平的联合预警模型对颈动脉斑块诊断效能较好。4)2型糖尿病史、入院高血压、Cl和TC是IS患者大动脉狭窄的独立危险因素;包括患者2型糖尿病史、Cl、TC、Cys C和NT-proBNP水平的联合预警模型对大动脉狭窄诊断效能较好。 结论 实验室指标与人口学信息和IS的发病及预后紧密相关,本研究开发模型经内、外部验证后临床应用价值较好,为IS的评估预警提供新的依据。
Other AbstractObjective To explore the correlation between clinical laboratory indicators and ischemic stroke (IS), and establish clinical models to evaluate and early warning the occurrence and development of IS through retrospective study. Methods The blood samples, demographic data, neurology scores, and imaging data of 300 IS patients who were admitted to the Department of Neurology of Lanzhou University Second Hospital from June 2019 to December 2020 were collected. The patient’s information was confirmed and supplemented through telephone consultation. Then, we entry the tested items of 90 common clinical laboratory indicators such as blood routine, biochemical items, coagulation, and thyroid function directly. Missing items and patient serum Lp-PLA2, CRP, NT-proBNP, IL-6, PCT, FFA were entered after supplementary testing. After stratifying the data based on the cerebral infarction area, degree of neurological deficit, carotid artery plaque and intracranial aortic stenosis in patients with IS, independent influencing factors and joint diagnostic model were determined by analysis of differences between groups, collinearity test, unconditional binary logistic regression, and ROC curve. Finally, the model calibration chart and nomogram in the R software were used to verify the early warning performance of the joint diagnosis model. Results 1) Cys C, CO2, PHOS, IBIL, ApoAⅠ/ApoB and educational level are independent influencing factors of cerebral infarction area in patients with IS;The diagnosis model including patient educational level, Cys C, CO2, PHOS, D dimer, ApoAⅠ/ApoB, ApoB levels has better diagnostic efficiency for non-lacunal cerebral infarction. 2) NE/HDL-C, ApoAⅠ/ApoB and education level are independent influencing factors of neurological deficit in IS patients;the diagnosis model including patient education level, FT3, NE/HDL-C, and ApoAⅠ/ApoB level is effective in the diagnosis of moderate to severe neurological deficit better. 3) Cys C, FIB and age are independent risk factors for carotid artery plaque in patients with IS;the diagnosis model including patient age, Glu, Cys C and FIB levels has a better diagnostic performance for carotid artery plaque. 4) History of type 2 diabetes, hospitalized hypertension, Cl and TC are independent risk factors for aortic stenosis in patients with IS;including the history of type 2 diabetes, a diagnostic model of Cl, TC, Cys C and NT-proBNP levels for the diagnosis of aortic stenosis is better. Conclusion Laboratory indicators and demographic information are closely related to the incidence and prognosis of IS. The models developed in this study have good clinical value after internal and external verification, which provides a new basis for IS evaluation and early warning.
Pages68
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/462384
Collection第二临床医学院
Affiliation第二临床医学院
First Author AffilicationSecond Clinical School
Recommended Citation
GB/T 7714
管沛文. 基于临床实验室指标评估预警缺血性卒中[D]. 兰州. 兰州大学,2021.
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