基于Dryad数据库预测动脉瘤性蛛网膜下腔出血术后发生脑积水风险列线图模型的构建与验证

doi:10.3969/j.issn.1004-583X.2025.04.003

摘要/Abstract

摘要：

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者术后发生脑积水的影响因素,构建并验证风险预测模型。方法收集2010年1月-2015年12月Dryad数据库中aSAH患者236例,按照7∶3的比例将患者随机分为训练集(n=166)和验证集(n=70)。采用单因素及多因素logistic回归分析,确定aSAH患者术后发生脑积水的独立危险因素,构建风险预测模型并绘制列线图。采用受试者工作特征曲线(ROC)、Calibration校准曲线及决策曲线分析(DCA)评价列线图模型的检验效能。结果多因素logistic回归分析结果显示,年龄≥60岁(HR=1.170,P=0.032)、开颅夹闭(HR=2.018,P=0.041)、脑室出血(HR=1.439,P=0.032)、再出血(HR=1.095,P<0.001)、迟发性脑缺血(HR=1.318,P=0.038)、机械通气时间延长(HR=3.112,P=0.012)是aSAH患者术后发生脑积水的独立危险因素(P<0.05)。据此,构建预测aSAH患者发生脑积水风险的列线图模型,训练集曲线下面积(AUC)为0.757,验证集AUC为0.667,校准曲线与理想曲线吻合良好,DCA曲线在0.20~0.80阈值概率范围内展示出较好的临床净收益。结论年龄≥60岁、开颅夹闭、脑室出血、再出血、迟发性脑缺血、机械通气时间延长是aSAH患者术后发生脑积水的独立危险因素,通过列线图模型,可预测aSAH患者术后发生脑积水的风险,为临床医生选择合适的个体化治疗方案提供参考。

关键词: 蛛网膜下腔出血, 脑积水, 影响因素, 列线图

Abstract:

Objective To explore the influencing factors for postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH), and to construct a nomogram and validate its performance. Methods A total of 236 aSAH patients with clinical data recorded in the Dryad database from January 2010 to December 2015 were collected. They were randomly divided into the training set (n=166) and validation set (n=70) at a ratio of 7∶3. Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors for postoperative hydrocephalus in aSAH patients, and a nomogram was therefore constructed. The receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the test efficiency of the nomogram. Results The results of multivariate logistic regression analysis showed that age≥60 years (HR=1.170, P=0.032), craniotomy clipping (HR=2.018, P=0.041), ventricular hemorrhage (HR=1.439, P=0.032), rebleeding (HR=1.095, P=0.001), delayed cerebral ischemia (HR=1.318, P=0.038), and prolonged mechanical ventilation time (HR=3.112, P=0.012) were independent risk factors for postoperative hydrocephalus in aSAH patients (all P<0.05). Based on this, a nomogram was constructed to predict the risk of postoperative hydrocephalus in aSAH patients. The area under the curve (AUC) was 0.757 in the training set, and 0.667 in the validation set. The calibration curve fitted well with the ideal curve, and the DCA curve showed good clinical net benefits within the threshold probability range of 0.20-0.80. Conclusion Age≥60 years, craniotomy clipping, ventricular hemorrhage, rebleeding, delayed cerebral ischemia, and prolonged mechanical ventilation time are independent risk factors for postoperative hydrocephalus in aSAH patients. The nomogram can be used to predict the incidence of postoperative hydrocephalus in aSAH patients, providing a reference for clinicians to select appropriate individualized treatment plans.

Key words: subarachnoid hemorrhage, hydrocephalus, influencing factors, nomogram

中图分类号:

R743.35

王壮壮, 任欢, 刘彦廷, 田春雷. 基于Dryad数据库预测动脉瘤性蛛网膜下腔出血术后发生脑积水风险列线图模型的构建与验证[J]. 临床荟萃, 2025, 40(4): 313-319.

Wang Zhuangzhuang, Ren Huan, Liu Yanting, Tian Chunlei. Construction of a nomogram to predict postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage based on the Dryad database and its validation[J]. Clinical Focus, 2025, 40(4): 313-319.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.04.003

https://lchc.magtechjournal.com/CN/Y2025/V40/I4/313

图/表 6

表1 训练集两组临床特征比较

Tab. 1 Clinical features of training set groups

项目	脑积水组(n=115)	非脑积水组(n=51)	$t$ /χ²值	P值
年龄(岁)	55.13±13.09	54.41±12.98	0.32	0.744
女性[例(%)]	70(60.87)	33(64.71)	0.22	0.730
高血压[例(%)]	72(62.61)	34(66.67)	0.29	0.861
吸烟[例(%)]	36(31.30)	18(35.29)	0.25	0.720
酗酒[例(%)]	12(10.43)	5(9.80)	0.02	0.902
糖尿病[例(%)]	5(4.35)	2(3.92)	0.90	0.016
心血管疾病[例(%)]	23(20.00)	8(15.69)	0.43	0.667
SAPSⅡ评分(分)	42.21±10.91	42.33±14.71	9.47	0.002
脑出血[例(%)]	62(53.91)	21(41.18)	2.29	0.178
早期脑损伤[例(%)]	84(73.04)	40(78.43)	0.54	0.461
DCI[例(%)]	39(33.91)	8(15.68)	5.78	0.016
再出血[例(%)]	21(18.26)	5(9.80)	1.91	0.167
血管痉挛[例(%)]	92(80.00)	21(41.18)	1.23	0.035
机械通气时间(d)	20.37±1.51	13.51±2.43	2.45	0.015
住院时间(d)	27.64±1.91	18.65±3.51	2.43	0.016
动脉瘤位置[例(%)]
前循环	104(90.43)	41(80.39)
后循环	9(7.82)	10(19.61)	1.24	<0.001
其他	1(1.75)	0(0.00)
GCS评分[例(%)]
≤5分	113(98.26)	50(98.04)
6~8分	2(1.74)	0(0.00)	3.14	0.208
≥9分	0(0)	1(1.96)
Fisher评分[例(%)]
Ⅰ	1(0.87)	0(0.00)
Ⅱ	2(1.73)	2(3.92)	1.44	0.696
Ⅲ	21(18.26)	11(21.57)
Ⅳ	91(79.13)	38(74.51)
手术方式[例(%)]
介入栓塞开颅夹闭	80(69.57) 35(30.43)	32(62.75) 19(37.25)	21.36	<0.001

表1 训练集两组临床特征比较

Tab. 1 Clinical features of training set groups

项目	脑积水组(n=115)	非脑积水组(n=51)	$t$ /χ²值	P值
年龄(岁)	55.13±13.09	54.41±12.98	0.32	0.744
女性[例(%)]	70(60.87)	33(64.71)	0.22	0.730
高血压[例(%)]	72(62.61)	34(66.67)	0.29	0.861
吸烟[例(%)]	36(31.30)	18(35.29)	0.25	0.720
酗酒[例(%)]	12(10.43)	5(9.80)	0.02	0.902
糖尿病[例(%)]	5(4.35)	2(3.92)	0.90	0.016
心血管疾病[例(%)]	23(20.00)	8(15.69)	0.43	0.667
SAPSⅡ评分(分)	42.21±10.91	42.33±14.71	9.47	0.002
脑出血[例(%)]	62(53.91)	21(41.18)	2.29	0.178
早期脑损伤[例(%)]	84(73.04)	40(78.43)	0.54	0.461
DCI[例(%)]	39(33.91)	8(15.68)	5.78	0.016
再出血[例(%)]	21(18.26)	5(9.80)	1.91	0.167
血管痉挛[例(%)]	92(80.00)	21(41.18)	1.23	0.035
机械通气时间(d)	20.37±1.51	13.51±2.43	2.45	0.015
住院时间(d)	27.64±1.91	18.65±3.51	2.43	0.016
动脉瘤位置[例(%)]
前循环	104(90.43)	41(80.39)
后循环	9(7.82)	10(19.61)	1.24	<0.001
其他	1(1.75)	0(0.00)
GCS评分[例(%)]
≤5分	113(98.26)	50(98.04)
6~8分	2(1.74)	0(0.00)	3.14	0.208
≥9分	0(0)	1(1.96)
Fisher评分[例(%)]
Ⅰ	1(0.87)	0(0.00)
Ⅱ	2(1.73)	2(3.92)	1.44	0.696
Ⅲ	21(18.26)	11(21.57)
Ⅳ	91(79.13)	38(74.51)
手术方式[例(%)]
介入栓塞开颅夹闭	80(69.57) 35(30.43)	32(62.75) 19(37.25)	21.36	<0.001

表2 aSAH患者术后发生脑积水的单因素及多因素logistic回归分析

Tab. 2 Univariate and multivariate logistic regression analyses of postoperative hydrocephalus in aSAH patients

变量	单因素分析		多因素分析
变量	OR(95%CI)	P值	OR(95%CI)	P值
年龄≥60岁	1.496(1.081~1.833)	0.009	1.170(1.060~1.343)	0.032
女性[例(%)]	1.159(0.585~2.296)	0.671	-	-
高血压[例(%)]	1.275(0.604~2.694)	0.523	-	-
吸烟[例(%)]	0.879(0.450~1.716)	0.707	-	-
酗酒[例(%)]	0.883(0.247~3.155)	0.848	-	-
糖尿病[例(%)]	2.075(0.226~19.021)	0.518	-	-
心血管疾病[例(%)]	1.333(0.546~3.252)	0.527	-	-
SAPSⅡ评分[例(%)]	1.040(0.691~1.565)	0.849	-	-
开颅夹闭[例(%)]	1.493(1.038~1.718)	<0.001	2.018(1.163~3.503)	0.041
脑室出血[例(%)]	1.414(1.214~1.799)	0.008	1.439(1.176~1.953)	0.032
再出血[例(%)]	1.456(1.211~1.984)	0.045	1.095(1.057~1.243)	<0.001
DCI[例(%)]	3.428(1.475~7.968)	0.004	1.318(1.096~1.576)	0.038
早期脑损伤[例(%)]	2.052(0.647~6.505)	0.221	-	-
血管痉挛[例(%)]	2.526(1.177~5.420)	0.057	-	-
机械通气时间(d)	2.320(1.378~3.907)	<0.001	3.112(1.840~5.309)	0.012
住院时间(d)	0.621(0.103~1.139)	0.090	-	-

图1 aSAH患者术后发生脑积水风险的列线图预测模型

Fig. 1 A nomogram to predict the risk of postoperative hydrocephalus in aSAH patients

图2 列线图模型预测脑积水发生风险的ROC曲线 a.训练集; b.验证集

Fig. 2 ROC curve for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

图3 列线图模型预测脑积水发生风险的校准曲线 a.训练集; b.验证集

Fig. 3 Calibration curve for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

图4 列线图模型预测脑积水发生风险的决策曲线 a.训练集;b.验证集

Fig. 4 DCA for validating the performance of the nomogram in predicting the risk of postoperative hydrocephalus in aSAH patients a. Training set; b. Validation set

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