基于真实世界研究的18~50岁人群急性缺血性卒中影响因素

doi:10.6040/j.issn.1671-7554.0.2024.0634

摘要/Abstract

摘要： 目的探讨真实世界中18~50岁人群急性缺血性卒中(acute ischemic stroke, AIS)的影响因素。方法依托山东省国家健康医疗大数据研究院的齐鲁全生命周期电子健康研究型数据库(Cheeloo Lifespan Electronic Health Reserch Data-library, Cheeloo LEAD),选取2012—2022年18~50岁首次诊断为AIS且有完整体检数据的个体组成AIS组,根据年龄、性别1∶2筛选非AIS个体作为非AIS组,采用多因素Logistic回归分析筛选与AIS发生相关的影响因素,旨在从真实世界中综合评价AIS发病的影响因素;利用列线图展示各影响因素的具体贡献,通过受试者工作特征曲线下面积(area under the curve, AUC)评价模型的效果。结果女性、吸烟、BMI升高、高血压、糖尿病、冠状动脉粥样硬化性心脏病、高脂血症、睡眠障碍、焦虑、慢性阻塞性肺疾病、哮喘、高同型半胱氨酸血症、卵圆孔未闭、心脏瓣膜病、偏头痛、风湿类疾病和脑出血是影响AIS的独立危险因素。基于此项17种危险因素建立的列线图模型AUC为0.803。结论在18~50岁人群中,AIS的发生与多系统疾病及生活方式因素显著相关,涵盖代谢性疾病(如高血压、糖尿病)、心血管疾病、精神神经障碍(如睡眠障碍、焦虑)及慢性炎症性疾病等。

关键词: 急性缺血性卒中, 影响因素, 真实世界, 列线图, 预测模型

Abstract: Objective To investigate the factors that contribute to the occurrence of acute ischemic stroke(AIS)in individuals aged 18 to 50 years in real-world settings. Methods This study employed data from the Cheeloo Lifespan Electronic Health Research Data-library(Cheeloo LEAD), housed within the National Health and Medical Big Data Research Institute of Shandong Province. The AIS group comprised individuals aged between 18 and 50 years who had been newly diagnosed with AIS during 2012-2022 and who had complete physical examination data. The non AIS group consisted of individuals without AIS, matched at a ratio of 1∶2 by age and sex. Multivariate Logistic regression analyses were conducted to identify factors associated with the occurrence of AIS. A nomogram was constructed to illustrate the contribution of each factor, and the models performance was evaluated using the area under the receiver operating characteristic curve(AUC). Results A total of 17 independent risk factors for AIS were identified, including female sex, smoking, elevated body mass index(BMI), hypertension, diabetes mellitus, coronary atherosclerotic heart disease, hyperlipidemia, sleep disorders, anxiety, chronic obstructive pulmonary disease, asthma, hyperhomocysteinemia, patent foramen ovale, valvular heart disease, migraine, rheumatic diseases, and intracerebral hemorrhage. A nomogram model was developed based on these risk factors, achieving an AUC of 0.803. Conclusion Among people aged 18 to 50, the occurrence of AIS is significantly associated with multi-system diseases and lifestyle factors, including metabolic diseases(such as hypertension and diabetes), cardiovascular diseases, mental and neurological disorders(such as sleep disorders and anxiety), and chronic inflammatory diseases, and so on.

Key words: Acute ischemic stroke, Influencing factors, Real-world study, Nomogram, Prediction model

中图分类号:

R743.3

孙爽爽,仉率杰,张伯韬,袁莹,于媛媛,薛付忠. 基于真实世界研究的18~50岁人群急性缺血性卒中影响因素[J]. 山东大学学报 (医学版), 2025, 63(9): 40-46.

SUN Shuangshuang, ZHANG Shuaijie, ZHANG Botao, YUAN Ying, YU Yuanyuan, XUE Fuzhong. Influencing factors of acute ischemic stroke in population during 18-50 years old: a real-world study analysis[J]. Journal of Shandong University (Health Sciences), 2025, 63(9): 40-46.

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