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| 基于血清TIMP3、MCP-4及8-OHdG构建脑卒中偏瘫患者重症肺炎风险预测模型与验证 |
| 作者：董宿利1 付继京2 |
| 单位：1. 河北工程大学附属医院 康复医学科, 河北 邯郸 056000; 2. 河北工程大学附属医院 重症医学科, 河北 邯郸 056000 |
| 关键词：脑卒中偏瘫 重症肺炎 金属蛋白酶组织抑制因子-3 单核细胞趋化蛋白-4 8-羟基脱氧鸟苷 风险预测模型 模型验证 |
| 分类号：R743.3;R563.1;R195.1 |
| 出版年·卷·期（页码）：2026·45·第三期（446-455） |
| 摘要： |
目的: 探讨基于血清金属蛋白酶组织抑制因子-3(TIMP3)、单核细胞趋化蛋白-4(MCP-4)、8-羟基脱氧鸟苷(8-OHdG)构建的脑卒中偏瘫患者并发重症肺炎风险预测模型的预测价值,为临床防治重症肺炎提供参考依据。方法: 前瞻性选取2021年5月至2025年3月河北工程大学附属医院710例脑卒中偏瘫患者,按照7∶3分为训练集(n=497)与验证集(n=213),根据住院期间患者有无并发重症肺炎分为发生组与未发生组。分析两组脑卒中偏瘫患者并发重症肺炎的影响因素,构建风险预测模型,并验证其预测性能。结果: 最终模型包含8个变量:糖尿病病史、意识障碍、侵入性操作、使用抗菌药物、白蛋白(ALB)、TIMP3、MCP-4、8-OHdG;在训练集、验证集中,ROC曲线显示,该风险预测模型的曲线下面积分别为0.976(95%CI:0.958~0.995)、0.960(95%CI:0.928~0.992);校准曲线、Hosmer-Lemeshow检验、决策曲线分析(DCA)显示,该风险预测模型具有较高的校准度及临床净获益。结论: 本研究成功构建了一个融合血清TIMP3、MCP-4及8-OHdG的脑卒中偏瘫患者并发重症肺炎风险预测模型,该模型具有优异的区分度、准确度及良好的临床预测效用,能为早期识别高危病例、个体化干预提供量化工具。 |
Objective: To explore the predictive value of the risk prediction model of stroke patients with hemiplegia complicated with severe pneumonia constructed by serum tissue inhibitor of metalloproteinase-3(TIMP3), monocyte chemoattractant protein-4(MCP-4), 8-hydroxy-deoxyguanosine(8-OHdG), so as to provide reference for clinical prevention and treatment of severe pneumonia. Methods: A total of 710 stroke patients with hemiplegia were prospectively selected at Affiliated Hospital of Hebei University of Engineering from May 2021 to March 2025. According to 7∶3, they were divided into a training set(n=497) and a validation set(n=213)at a ratio of 7∶3. According to whether patients had severe pneumonia during hospitalization, they were divided into an occurrence group and a non-occurrence group. The influencing factors of severe pneumonia between the two groups of stroke patients with hemiplegia were analyzed, and the risk prediction model was constructed and its prediction performance was verified. Results: The final model included 8 variables: history of diabetes, disturbance of consciousness, invasive operation, use of antibiotics, albumin(ALB), TIMP3, MCP-4, and 8-OHdG; in the training set and the validation set, the ROC curve showed that the area under the curve of the risk prediction model was 0.976(95%CI:0.958-0.995) and 0.960(95%CI:0.928-0.992), respectively. The calibration curve, Hosmer-Lemeshow test and decision curve analysis(DCA) showed that the risk prediction model had high calibration and clinical net benefit. Conclusion: In this study, a risk prediction model of severe pneumonia in stroke patients with hemiplegia is successfully constructed by combining serum TIMP3, MCP-4 and 8-OHdG. The model has excellent discrimination, accuracy and good clinical predictive utility, which can provide a quantitative tool for early identification of high-risk cases and individualized intervention. |
| 参考文献： |
[1] BEI N,LONG D,BEI Z,et al.Effect of water exercise therapy on lower limb function rehabilitation in hemiplegic patients with the first stroke[J].Altern Ther Health Med,2023,29(7):429-433. |
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