中华老年心脑血管病杂志

目的 分析急性缺血性脑卒中患者步态异常的早期风险标志物，并构建预警模型。方法 纳入2023年1月至2025年1月于解放军总医院接受治疗的急性缺血性脑卒中患者300例，依据患者发病后3个月是否表现出步态异常情况分为异常组105例和正常组195例，收集患者一般资料，使用均方根曲线构建列线图预测模型，并评估其准确度与一致性；采用ROC曲线评估列线图的临床预测价值。结果 步态异常组年龄、美国国立卫生研究院卒中量表（National Institutes of Health Stroke scale,NIHSS）（下肢）评分、弥散加权成像（diffusion-weighted imaging,DWI）早期病灶体积、皮质脊髓束（corticospinal tract,CST）受累程度1级、神经元特异性烯醇化酶（neuron-specific enolase,NSE）、超敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）水平明显高于正常组，功能步态分级（functional ambulation classification,FAC）明显低于正常组（P<0.05,P<0.01）。基于年龄、NIHSS（下肢）评分、简易精神状态检查表（mini-mental state examination,MMSE）评分、FAC、DWI早期病灶体积、CST受累程度、NSE和hs-CRP构建预测模型，列线图内部验证一致性指数为0.979(95%CI:0.975～0.983),ROC曲线下面积为0.985(95%CI:0.975～0.994)。结论 急性缺血性脑卒中患者预后步态异常的早期风险因素包括年龄、NIHSS评分、DWI早期病灶体积、CST受累程度、NSE以及hs-CRP，保护因素包括MMSE、FAC，基于这些因素构建的列线图模型具有较好的预测性能。

Objective To analyze early risk markers for post-stroke abnormal gait prognosis in patients with acute ischemic stroke and to construct an early warning model. Methods A total of 300 acute ischemic stroke patients in our hospital from January 2023 to January 2025 were recruited. Based on the presence of gait abnormality at 3 months after onset, they were divided into an abnormal group(n=105) and a normal group(n=195). General patient data were collected, and a nomogram prediction model was constructed using root mean square curve analysis, and its accuracy and consistency were evaluated. ROC curve was plotted to assess the clinical predictive value of the nomogram. Results The abnormal group exhibited significantly advanced age, higher score of National Institutes of Health Stroke scale(NIHSS)(lower limb), larger volume of early lesions by diffusion-weighted imaging(DWI), more corticospinal tract(CST) involved, and increased levels of neuron-specific enolase(NSE), and high-sensitivity C-reactive protein(hs-CRP), but significantly lower class of Functional Ambulation Classification(FAC) compared with the normal group(P<0.05, P<0.01). A predictive model was constructed based on age, NIHSS score(lower limb), score of Mini-Mental State Examination(MMSE), FAC, early DWI lesion volume, degree of CST involvement, and NSE and hs-CRP levels. The consistency index of internal validation was 0.979(95%CI:0.975-0.983), with an AUC value of 0.985(95%CI:0.975-0.994). Conclusion Early risk factors for post-stroke gait abnormality in acute ischemic stroke patients include age, NIHSS score, early DWI lesion volume, degree of CST involvement, NSE, and hs-CRP, while protective factors include MMSE score and FAC. The nomogram model constructed based on these factors demonstrates favorable predictive performance.