Construction and evaluation of a model for predicting ischemic stroke risk in patients with sudden sensorineural hearing loss
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摘要: 目的 探讨突发性聋并发缺血性脑卒中的相关因素，构建其风险预测模型，并验证该模型的预测效果。方法 回顾性分析2017年1月—2020年12月于连云港市第一人民医院住院的突发性聋患者901例，按照是否并发缺血性脑卒中分为缺血性脑卒中组100例和突发性聋组801例，对2组资料行单因素分析、多变量Logistic回归模型筛选突发性聋并发缺血性脑卒中的独立相关因素，并建立风险预测模型及内部验证。将原始数据按7∶3随机分为建模组631例和验证组270例，采用Hosmer-Lemeshow和受试者操作特征曲线分别检验模型的拟合优度及预测效果。结果 年龄、中性粒细胞比率(NEUR)、中性粒细胞计数(NC)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、尿素氮(BUN)、TC-HDL-C、TG/HDL-C、低密度脂蛋白胆固醇(LDL-C)/HDL-C、血同型半胱氨酸(Hcy)、血纤维蛋白原(FIB)、颈部血管斑块是突发性聋并发缺血性脑卒中发生的相关因素(均P < 0.05)。最终纳入年龄(OR=2.816)、NEUR(OR=2.707)、Hcy(OR=88.833)、FIB(OR=1.389)、TC-HDL-C(OR=1.613)、颈部血管斑块(OR=2.862)6个因素构建出风险预测模型。Hosmer-Lemeshow检验结果，建模组ROC曲线下面积为0.846，P=0.555，Youden指数为0.564，灵敏度为0.820，特异度为0.744。验证组ROC曲线下面积为0.847，P=0.288，Youden指数为0.432，灵敏度为0.783，特异度为0.649。结论 该研究构建的风险预测模型一致性和预测效果良好，可为临床预测评估突发性聋并发缺血性脑卒中发生风险提供借鉴，并实施早期干预。Abstract: Objective To explore the related factors of sudden sensorineural hearing loss complicated with ischemic stroke, construct the risk prediction model, and verify the prediction effect of the model.Methods A retrospective analysis was performed on 901 sudden sensorineural hearing loss patients hospitalized from January 2017 to December 2020, The patients were divided into the ischemic stroke group(100 cases) and the sudden deafness group(801 cases) according to whether they were complicated with ischemic stroke, The independent correlation factors of sudden deafness complicated with ischemic stroke were screened by univariate analysis and multivariate Logistic regression model, and the risk prediction model and internal verification were established. The original data were randomly divided into the modeling group(631 cases) and the validation group(270 cases) at a 7∶3 ratio. Hosmer-Lemeshow and receiver operating characteristic curve were used to test the goodness of fit and predictive effect of the model, and 270 patients were included again in the application research of the model and to test the prediction effect of the model.Results The results of single factor analysis showed that age, NEUR, NC, NLR, PLR, TC, HDL-C, BUN, TC-HDL-C, TG/HDL-C, LDL-C/HDL-C, Hcy, FIB and cervical vascular plaque were related factors of sudden sensorineural hearing loss complicated with ischemic stroke(P < 0.05). Age(OR=2.816), NEUR(OR=2.707), Hcy(OR=88.833), FIB(OR=1.389), TC-HDL-C(OR=1.613), cervical vascular plaque(OR=2.862) are the independent risk factors of SNHL complicated with ischemic stroke. These 6 factors are used to construct a prediction model. Hosmer-lemeshow test results, the area under the ROC curve of the modeling group was 0.846, P=0.555, Youden index was 0.564, sensitivity was 0.820, and specificity was 0.744. In the validation group, the area under ROC curve was 0.847, P=0.288, Youden index was 0.432, sensitivity was 0.783, and specificity was 0.649.Conclusion The risk prediction model constructed in this study shows good prediction efficiency. which can provide references for the clinical screening of ischemic stroke risks in patients with sudden sensorineural hearing loss and early interventions in early stage.
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Key words:
- deafness, sudden /
- stroke /
- brain ischemia /
- risk prediction model
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表 1 自变量赋值表
自变量 赋值方式 自变量 赋值方式 年龄/岁 >60=1，≤60=0 性别 男=1，女=2 WBC/(×109·L-1) >1=1，≤1=0 HDL-C/(mmol·L-1) >1.74=1，≤1.74=0 NEUR/% >75=1，≤75=0 LDL-C/(mmol·L-1) >3.61=1，≤3.61=0 NC/(×109·L-1) >6.3=1，≤6.3=0 脂蛋白a/(mg·L-1) >300=1，≤300=0 LC/(×109·L-1) >3.2=1，≤3.2=0 Cr/(μmol·L-1) >97=1，≤97=0 Hb/(g·L-1) (男/女)>120/110=1，≤120/110=0 BUN/(mmol·L-1) >8.2=1，≤8.2=0 PLT/(×109·L-1) >300=1，≤300=0 Hcy/(μmol·L-1) >10=1，≤10=0 MPV/fL >13=1，≤13=0 GLU/(mmol·L-1) >6.1=1，≤6.1=0 ALB/(g·L-1) >35=1，≤35=0 D-二聚体/(ng·mL-1) >243=1，≤243=0 TC/(mmol·L-1) >5.17=1，≤5.17=0 FIB/(g·L-1) >4.98=1，≤4.98=0 TG/(mmol·L-1) >1.78=1，≤1.78=0 颈部血管斑块 是=1，否=0 
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表 2 突发性聋并发缺血性脑卒中风险的单因素分析
例(%) 项目 突发性聋组(n=801) 缺血性脑卒中组(n=100) U/t P 项目 突发性聋组(n=801) 缺血性脑卒中组(n=100) U/t P 年龄/岁 36.250 < 0.001 HDL-C - 0.016 >60 593(73.2) 45(45.0) 是 78(9.7) 10(10.0) ≤60 208(26.8) 55(55.0) 否 723(90.3) 90(90.0) 性别 0.158 0.691 LDL-C 3.659 0.056 男 442(55.2) 52(52.0) 是 121(15.1) 8(8.0) 女 359(44.8) 48(48.0) 否 680(84.9) 92(92.0) WBC 0.039 0.844 脂蛋白a 0.437 0.508 是 248(31.0) 30(30.0) 是 127(15.9) 19(19.0) 否 553(69.0) 70(70.0) 否 674(84.1) 81(81.0) NEUR 22.409 < 0.001 Cr 0.588 0.443 是 278(34.7) 41(41.0) 是 23(2.9) 1(1.0) 否 523(65.3) 59(59.0) 否 778(97.1) 99(99.0) NC 15.324 < 0.001 BUN - < 0.001 是 454(56.7) 36(36.0) 是 26(3.5) 12(12.0) 否 347(43.3) 64(64.0) 否 775(96.5) 88(88.0) LC 0.947 0.330 GLU - 0.431 是 19(2.7) 4(4.0) 是 436(54.4) 54(54.0) 否 782(97.3) 96(96.0) 否 365(45.6) 46(46.0) HB 0.615 0.433 D-二聚体 0.003 0.959 是 753(94) 92(92.0) 是 41(5.4) 5(5.0) 否 48(6.0) 8(8.0) 否 760(94.6) 95(95.0) PLT 0.150 0.699 Hcy 44.540 < 0.001 是 82(10.5) 9(9.0) 是 215(26.84) 60(60.0) 否 719(89.5) 91(91.0) 否 586(73.16) 40(40.0) MPV 3.747 0.053 颈部血管斑块 14.980 < 0.001 是 11(1.7) 4(4.0) 是 212(26.47) 55(55.0) 否 790(98.3) 96(96.0) 否 589(73.53) 45(45.0) ALB 0.498 0.480 FIB/(g·L-1) 2.75±0.68 3.01±0.74 3.570 < 0.001 是 779(97.3) 96(96.0) NLR 4.17±3.50 5.21±6.49 2.486 0.013 否 22(2.7) 4(4.0) PLR 167.0±88.77 183.1±66.4 2.840 < 0.001 TC 7.163 0.007 TC-HDL-C/(mmol·L-1) 3.17±1.00 3.64±0.93 4.828 < 0.001 是 257(32.3) 19(19.0) TC/HDL-C 3.82±1.00 3.61±1.12 1.881 0.060 否 544(67.7) 81(81.0) TG/HDL-C 0.99±1.26 1.35±1.49 -2.579 0.010 TG 1.140 0.286 LDL-C/HDL-C 1.96±0.74 2.23±0.72 3.550 < 0.001 是 7(1.1) 2(2.0) 否 794(98.9) 98(98.0)
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表 3 突发性聋并发缺血性脑卒中风险的多因素分析
影响因素 变量 β 标准误 Wald OR 95%CI P 年龄 x1 1.035 0.331 9.789 2.816 1.472~5.387 0.002 NEUR x2 0.808 0.333 5.886 2.707 1.174~4.429 0.015 Hcy x3 4.487 0.369 147.495 88.833 43.063~183.249 0.000 颈部血管斑块 x4 1.052 0.367 8.211 2.862 1.394~5.875 0.004 FIB x5 0.328 0.164 4.030 1.389 1.008~1.913 0.045 TC-HDL-C x6 0.381 0.182 4.371 1.613 1.078~1.976 0.037 (常量) -8.830 1.274 48.001 - - 0.000
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