脑梗死患者并发急性胃肠损伤的影响因素分析及预测模型构建-现代医学

脑梗死患者并发急性胃肠损伤的影响因素分析及预测模型构建

单位：海军军医大学第一附属医院(上海长海医院) 脑血管病中心内科, 上海 200433

分类号：R743

出版年·卷·期（页码）：2026·45·第四期（627-634）

摘要：

目的： 分析急性脑梗死(ACI)患者并发急性胃肠损伤(AGI)的影响因素并构建预测模型。方法： 回顾性分析2022年6月至2025年5月我院收治的145例ACI患者，根据患者入院1周内是否发生AGI分为AGI组与参照组。收集并比较两组临床资料，采用多因素Logistic回归分析ACI患者并发AGI的关联因素，构建回归预测模型；采用受试者工作特征(ROC)曲线评价模型预测能力；自助法(Bootstrap)对模型进行内部验证；霍斯默-莱梅肖(H-L)拟合优度检验、校准曲线评价模型校准度。结果： 145例ACI患者中76例发生AGI，发生率为52.41%。Logistic回归分析显示，伴肺部感染(OR=4.266)、卒中前衰弱(OR=3.119)与入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.789)高、应激性高血糖比值(SHR)(OR=14.842)高均是ACI患者并发AGI的独立危险因素，行早期肠内营养(OR=0.405)、腹部按摩(OR=0.362)均为保护因素(P＜0.05)。基于独立影响因素构建回归预测模型，ROC曲线显示，模型预测患者发生AGI的曲线下面积(AUC)为0.923(95%CI 0.884～0.963)，经Bootstrap法内部验证获得一致性指数为0.909。H-L检验结果显示 χ²＝11.802，P=0.107，校准曲线显示预测概率与实际概率高度吻合。结论： ACI患者AGI发生率较高，入院时NIHSS评分、SHR水平、伴肺部感染、卒中前衰弱、行早期肠内营养及腹部按摩均是其重要影响因素，据此构建的预测模型具有良好的预测效能。

Objective: To analyze the influencing factors for acute gastrointestinal injury(AGI) in patients with acute cerebral infarction(ACI) and to construct a prediction model. Methods: A retrospective analysis was conducted on 145 ACI patients admitted to our hospital from June 2022 to May 2025. According to whether AGI occurred within 1 week after admission, patients were assigned to AGI group or reference group. Clinical data of both groups were collected and compared. Multivariate logistic regression was used to analyze the associated factors for AGI in ACI patients, and a regression prediction model was constructed. Receiver operating characteristic(ROC) curve was used to evaluate the predictive performance of the model. Bootstrap method was used for internal validation of the model. Hosmer-Lemeshow(H-L) goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. Results: Among the 145 ACI patients, 76 cases developed AGI, with an incidence of 52.41%. Logistic regression analysis showed that concomitant pulmonary infection(OR=4.266), pre-stroke frailty(OR=3.119), high National Institutes of Health Stroke Scale(NIHSS) score at admission(OR=1.789), and stress hyperglycemia ratio(SHR)(OR=14.842) were all independent risk factors for AGI in ACI patients, while early enteral nutrition(OR=0.405) and abdominal massage(OR=0.362) were protective factors(P<0.05). A regression prediction model was constructed based on the independent influencing factors. The ROC curve showed that the area under the curve(AUC) of the model for predicting AGI occurrence in patients was 0.923(95%CI 0.884-0.963). Internal validation by Bootstrap method yielded a concordance index of 0.909. H-L test results showed χ²=11.802, P=0.107. The calibration curve showed high consistency between the predicted probability and actual probability. Conclusion: The incidence rate of AGI in ACI patients is relatively high. NIHSS score at admission, SHR level, concomitant pulmonary infection, pre-stroke frailty, early enteral nutrition, and abdominal massage are all important influencing factors. The prediction model constructed accordingly demonstrates good predictive efficacy.

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