脑卒中患者左右颈七交叉移位术后肺部感染风险预测模型的建立

龚怡雯; 刘莹; 徐业

doi:10.16766/j.cnki.issn.1674-4152.004173

脑卒中患者左右颈七交叉移位术后肺部感染风险预测模型的建立

doi: 10.16766/j.cnki.issn.1674-4152.004173

上海市静安区中心医院手及上肢外科，上海 200040

基金项目:

2024年度医疗服务与保障能力提升(国家临床重点专科建设)项目 10000015Z155080000004

上海市静安区卫生健康科研项目 2024HL02

详细信息

通讯作者:
徐业，E-mail: uyexx0712@126.com

中图分类号: R651.12 R743.3
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- 文章访问数: 3
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出版历程
- 收稿日期: 2024-11-15
- 网络出版日期: 2025-11-17

Construction and validation of a logistic regression model for predicting pulmonary infection risk in stroke patients undergoing left-right contralateral C₇ nerve transfer surgery

Department of Hand and Upper Limb Surgery, Jing' an District Central Hospital, Shanghai 200040, China

摘要

摘要: 目的选择评估脑卒中患者左右颈七交叉移位术后肺部感染风险的敏感指标或指标组合，建立并验证风险预测列线图模型，为临床病情评估及临床决策提供支持。方法回顾性选取2021年3月—2023年12月在上海市静安区中心医院行左右颈七交叉移位术的脑卒中患者294例。根据肺部感染诊断标准将患者分为感染组(29例)和未感染组(265例)。收集2组人口学统计指标、实验室指标等数据资料，采用LASSO和logistic回归分析脑卒中患者左右颈七交叉移位术后肺部感染危险因素，建立术后肺部感染风险预测列线图模型，绘制ROC曲线分析列线图模型的效能并验证其稳定性。结果 2组患者年龄、合并糖尿病、最大呼气量(PEF)、一秒率(FEV₁/FVC)、最大肺活量(VCmax)、手术时间、Beck评分、美国麻醉医师协会(ASA)分级、术前肌电图异常情况比较，差异均有统计学意义(P < 0.05)。多因素LASSO回归分析显示，λ.1se=0.040 7时，最终有7个预测因子符合特征。多因素分析显示，年龄>60岁、Beck评分高为脑卒中患者左右颈七交叉移位术后肺部感染的独立危险因素，PEF≥320 L/min、FEV₁/FVC≥92%为保护因素(P < 0.05)。模型AUC为0.983(95% CI: 0.968~0.998)，灵敏度、特异度分别为0.931、0.936。内部验证Bootstrap(B=1 000)显示预测效能稳定，决策曲线分析表明模型具有正向净收益率。结论年龄>60岁、Beck评分高为脑卒中患者左右颈七交叉移位术后肺部感染的独立危险因素，PEF≥320 L/min、FEV₁/FVC≥92%为保护因素，建立的列线图模型对肺部感染有良好的预测效能，可为临床评估决策提供数据支撑。
- 脑卒中 /
- 左右颈七交叉移位术 /
- 肺部感染 /
- 预测模型
Abstract: Objective To identify sensitive indicators for assessing pulmonary infection risk in stroke patients following left-right contralateral C₇ nerve transfer surgery, and to develop and validate a risk-prediction nomogram to support clinical condition assessment and clinical decision-making. Methods A retrospective analysis was conducted on 294 stroke patients who underwent left-right contralateral C₇ nerve transfer surgery at Jing' an District Central Hospital between March 2021 and December 2023. Patients were stratified into an infection group (n=29) and a non-infection group (n=265) based on standardized diagnostic criteria for pulmonary infection. Demographic statistical indicators, laboratory indicators and other data of the two groups were collected. LASSO and logistic regression were used to analyze the risk factors of pulmonary infection after the left-right contralateral C₇ nerve transfer surgery of stroke patients. The postoperative pulmonary infection risk prediction model was established, and the ROC curve was evaluated to analyze the efficiency and verify the stability of the model. Results There were significant differences in age, diabetes mellitus, peak expiratory flow (PEF), FEV₁/FVC, VCmax, operation time, Beck score, American Society of Anesthesiologists (ASA) grading, and preoperative EMG abnormalities between the two groups (P < 0.05). Multifactor LASSO regression analysis showed that when λ. 1se=0.040 7, 7 predictors finally fit the characteristics. Multivariate analysis identified that age >60 years old and high Beck score as independent risk factors, while PEF≥320 L/min and FEV₁/FVC≥92% were protective factors (P < 0.05). The model achieved an AUC of 0.983 (95% CI: 0.968-0.998), with sensitivity and specificity of 0.931 and 0.936, respectively. Internal validation Bootstrap (B=1 000) confirmed stable predictive performance, and decision curve analysis showed clinical utility. Conclusion Age>60 years old and elevated Beck score are independent risk factors, whereas PEF≥320 L/min and FEV₁/FVC≥92% are protective factors. The nomogram model showed excellent predictive effect on pulmonary infection, and can provide data support for clinical evaluation and decision-making.
- Stroke /
- left-right contralateral C₇ nerve transfer surgery /
- Pulmonary infection /
- Prediction model

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图 1 惩罚系数λ与模型误差

Figure 1. Penalty coefficient λ versus model error

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图 2 脑卒中患者左右颈七交叉移位术后肺部感染发生风险预测的列线图

Figure 2. Nomogram for predicting the risk of pulmonary infection after left and right cervical seven crossing transposition in stroke patients

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图 3 左右颈七交叉移位术后肺部感染风险预测列线图模型的校准曲线

Figure 3. Calibration curve of the nomogram model for predicting the risk of pulmonary infection after the left and right seven crossed cervicoplasty

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图 4 左右颈七交叉移位术后肺部感染风险预测列线图模型的决策曲线

Figure 4. Decision curve of the nomogram model for predicting the risk of pulmonary infection after the left and right seven crossed cervical transposition

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表 1 2组脑卒中行左右颈七交叉移位术的患者临床资料比较[例(%)]

Table 1. Comparison of clinical data between the two groups of patients with stroke who underwent left and right cervical seven crossing transposition[cases(%)]

项目	未感染组(n=265)	感染组(n=29)	χ²值	P值	项目	未感染组(n=265)	感染组(n=29)	χ²值	P值
性别			0.859	0.354	PaO₂(mmHg)			0.158	0.691
男性	195(73.58)	19(65.52)			正常	263(99.25)	28(96.55)
女性	70(26.42)	10(34.48)			异常	2(0.75)	1(3.45)
年龄(岁)			34.347	< 0.001	PaCO₂(mmHg)			0.519	0.471
≤60	232(87.55)	13(44.83)			正常	264(99.62)	28(96.55)
>60	33(12.45)	16(55.17)			异常	1(0.38)	1(3.45)
BMI			0.483	0.487	FEV₁(L)			< 0.001	0.999
< 28	258(97.36)	27(93.10)			< 1	0	0
≥28	7(2.64)	2(6.90)			≥1	265(100.00)	29(100.00)
吸烟			2.782	0.095	PEF(L/min)			112.392	< 0.001
无	202(76.23)	18(62.07)			< 320	22(8.30)	25(86.21)
有	63(23.77)	11(37.93)			≥320	243(91.70)	4(13.79)
合并高血压			2.197	0.138	FEV₁/FVC(%)			108.582	< 0.001
无	101(38.11)	7(24.14)			< 92	18(6.79)	23(79.31)
有	164(61.89)	22(75.86)			≥92	247(93.21)	6(20.69)
合并糖尿病			4.166	0.041	VCmax(%)			75.336	< 0.001
无	194(73.21)	16(55.17)			< 70	7(2.64)	14(48.28)
有	71(26.79)	13(44.83)			≥70	258(97.36)	15(51.72)
脑卒中类型			1.033	0.309	手术时间(h)			40.305	< 0.001
脑出血	129(48.68)	17(58.62)			< 3	224(84.53)	10(34.48)
脑梗死	136(51.32)	12(41.38)			≥3	41(15.47)	19(65.52)
白蛋白(g/L)			< 0.001	0.999	Beck评分			75.305	< 0.001
< 30	2(0.75)	0			无	139(52.45)	0
≥30	263(99.25)	29(100.00)			轻度	111(41.89)	11(37.93)
白细胞(×10⁹/L)			0.908	0.635	中度	15(5.66)	14(48.28)
降低	3(1.13)	0(6.90)			重度	0	4(13.79)
正常	258(97.36)	28(96.55)			ASA分级			54.885	< 0.001
增高	4(1.51)	1(3.45)			1级	32(12.08)	2(6.90)
CRP(mg/L)			2.320	0.128	2级	207(78.11)	6(20.69)
< 10	262(98.87)	27(93.10)			3级	26(9.81)	21(72.41)
≥10	3(1.13)	2(6.90)			术前肌电图			67.759	< 0.001
血红蛋白(g/L)			0.158	0.691	正常	260(98.11)	17(58.62)
< 90	2(0.75)	1(3.45)			异常	5(1.89)	12(41.38)
≥90	263(99.25)	28(96.55)			术中PEEP			1.818	0.178
					正常	265(100.00)	28(96.55)
					异常	0	1(3.45)
注：1 mmHg=0.133 kPa。

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表 2 变量赋值情况

Table 2. Variable assignment situation

变量	赋值方法
左右颈七交叉移位术后肺部感染状态	未感染=0，感染=1
年龄	≤60岁=0，>60岁=1
PEF(L/min)	< 320=0，≥320=1
FEV₁/FVC(%)	< 92=0，≥92=1
VCmax(%)	< 70=0，≥70=1
Beck评分	无=0，轻度=1，中度=2，重度=3
ASA分级	1级=1，2级=2，3级=3
术前肌电图	正常=0，异常=1

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表 3 脑卒中患者左右颈七交叉移位术后肺部感染的多因素logistic回归分析结果

Table 3. Results of multivariate logistic regression analysis of pulmonary infection after left and right cervical seven cross transposition in stroke patients

变量	Β	SE	Wald χ²	P值	OR(95% CI)
年龄	2.772	1.262	4.825	0.028	15.993(1.348~189.766)
PEF	-2.733	1.265	4.666	0.031	0.065(0.005~0.776)
FEV₁/FVC	-2.774	1.077	6.630	0.010	0.062(0.008~0.516)
VCmax	-2.818	1.551	3.300	0.069	0.060(0.003~1.249)
Beck评分	2.914	0.976	8.915	0.003	18.434(2.722~124.849)
ASA分	1.702	0.914	3.470	0.062	5.487(0.915~32.908)
肌电图	1.537	1.352	1.293	0.255	4.651(0.329~65.755)

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