Abstract: Objective To investigate the risk factors for cerebral infarction as the initial symptom in patients with ischemic moyamoya disease(MMD) so as to identify and prevent it early. Methods The clinical data and initial blood test indicators of 423 patients with ischemic MMD admitted to Anhui Provincial Hospital from May 2015 to January 2022 were retrospectively collected.The clinical data and blood test indicators of the patients were analyzed statistically by SPSS 26.0 and R 4.3.0 software,including univariate risk factor analysis and multivariate Logistic regression analysis to find the independent risk factors and establish a clinical prediction model. Results Smoking,platelet,systolic blood pressure,and high-density lipoprotein(HDL) were the independent risk factors for cerebral infarction as the initial symptom in patients with ischemic MMD.A logistic regression prediction model was established,and the area under the ROC curve was 0.712,which was further validated by ROC curve,calibration curve,and clinical decision curve(DCA).The prediction model has a certain predictive value for cerebral infarction as the initial symptom in patients with ischemic MMD. Conclusion The developed ROC chart has reference value and clinical application value for clinicians to predict the initial symptom of cerebral infarction in patients with ischemic moyamoya disease.

Key words: Moyamoya disease, Cerebral infarction, Risk factors, Clinical prediction models

摘要： 目的 探究缺血型烟雾病患者以脑梗死发生为首发症状的危险因素,以便早期识别及预防。方法 回顾性收集安徽省立医院2015年5月至2022年1月缺血型烟雾病(MMD)共计423例患者的一般临床资料及初次入院后的部分血液检验指标。根据患者的入院症状分为脑梗死组与非脑梗死组(包括头痛、头晕、短暂性脑缺血发作(TIA)、无症状),对两组的临床资料及血液指标通过SPSS 26.0与R 4.3.0语言软件进行统计学分析,包括单因素危险因素分析及多因素Logistic回归分析,寻找单独危险因素,建立临床预测模型。结果 吸烟、血小板、收缩压、高密度脂蛋白(HDL)为缺血型烟雾病患者首发症状为脑梗死的独立影响因素。建立logistic回归预测模型,ROC曲线下面积为0.712,并再用受试者工作特征曲线(ROC)、校准曲线和临床决策曲线(DCA)验证,预测模型对于缺血型烟雾病患者首发症状为脑梗死症状有一定预测作用。结论 本研究中开发的列线图对于临床医生预测缺血型烟雾病患者首发出现脑梗死症状具有参考价值和临床转化应用价值。

关键词: 烟雾病, 脑梗死, 危险因素, 临床预测模型