[1]李 鹏,王亚杰,范昆鹏.基于机器学习构建锁骨下动脉支架植入术后再狭窄的风险预测模型[J].介入放射学杂志,2026,(09):1054-1062.[doi:10.3969/j.issn.1008-794X.2026.09.015]
　LI Peng,WANG Yajie,FAN Kunpeng..The establishment of a risk prediction model for in-stent restenosis after subclavian artery stenting based on machine learning[J].J Intervent Med,2026,(09):1054-1062.[doi:10.3969/j.issn.1008-794X.2026.09.015]
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基于机器学习构建锁骨下动脉支架植入术后再狭窄的风险预测模型()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2026年09
页码:
1054-1062
栏目:
临床研究
出版日期:
2026-09-10

文章信息/Info

Title:
The establishment of a risk prediction model for in-stent restenosis after subclavian artery stenting based on machine learning
文章编号:
1008-794X(2026)-009-1054-09
作者:
李 鹏;  王亚杰;  范昆鹏
471000 河南洛阳 河南科技大学第一附属医院影像科(李 鹏),神经内科(王亚杰、范昆鹏)
Author(s):
LI Peng; WANG Yajie; FAN Kunpeng.
Department of Medical Imaging,First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan Province 471000,China
关键词:
机器学习;  锁骨下动脉;  支架内再狭窄;  预测模型
分类号:
R543.5
DOI:
10.3969/j.issn.1008-794X.2026.09.015
文献标志码:
B
摘要:
目的 基于锁骨下动脉支架(subclavian artery stenting,SAS)植入患者的临床资料建立机器学习模型,用于预测支架内再狭窄(in-stent restenosis,ISR)的风险。方法 回顾性分析2018年1月至2023年3月在河南科技大学第一附属医院住院的SAS植入患者212例。根据术后1年内患者是否发生ISR分为ISR组和非ISR组。将数据集按照7:3随机分为训练集(148例,建模)和测试集(64例,验证)。对训练集中变量进行单因素、多因素logistic回归分析,筛选出SAS植入患者ISR的独立预测因素,并建立逻辑回归、K-最近邻、支持向量机、随机森林、决策树、反向传播神经网络和梯度提升机共 7 个机器学习模型。模型性能评估采用受试者工作特征曲线下面积(AUC)、敏感度、特异度、准确度、Brier分数和校准图。结果 纳入的212例SAS植入患者中术后1年内发生ISR者22例(10.37%),训练集中多因素 logistic回归分析显示慢性阻塞性肺疾病(OR=6.43,95%CI:1.60～25.82,P=0.009)、术前狭窄长度(OR=4.04,95%CI:1.18～13.90,P=0.027)、术前钙化斑块(OR=3.79,95%CI:1.01～14.23,P=0.049)和残余狭窄(OR=28.67,95%CI:2.02～406.61,P=0.013)是ISR的独立影响因素。在测试集中,逻辑回归、 K-最近邻、支持向量机、随机森林、决策树、反向传播神经网络和梯度提升机模型的AUC均较高,分别为0.929(95%CI:0.837～0.992)、0.850(95%CI:0.484～1.000)、0.962(95%CI:0.879～1.000)、0.954(95%CI:0.889～1.000)、0.925(95%CI:0.837～0.988)、0.929(95%CI:0.837～0.992)和0.912(95%CI:0.816～0.988); Delong检验显示各个模型之间预测效能差异无统计学意义(均P>0.05)。结论 机器学习模型预测SAS植入患者术后ISR效能较高,有助于临床医生识别高危ISR患者并及时做出临床决策。

参考文献/References:

[1] Zhao TY,Xu GQ,Xue JY,et al.Effects of percutaneous endovascular angioplasty for severe stenosis or occlusion of subclavian artery[J].Sci Rep,2024,14:14290.
[2]王力力,华 扬,贾凌云,等.锁骨下动脉支架置入术后再狭窄的发生率及其影响因素分析[J].中华医学超声杂志(电子版),2019,16:762-767.
Wang LL,Hua Y,Jia LY,et al.Incidence and influencing factors of restenosis after subclavian artery stent implantation[J].Chin J Med Ultrasound Electron Ed,2019,16:762-767.
[3]徐佳波,孙 捷,郎德海.腔内介入治疗在锁骨下动脉窃血综合征中的应用及预后分析[J].现代实用医学,2024,36:630-632.
Xu JB,Sun J,Lang DH.Application and prognosis analysis of endovascular interventional therapy in subclavian steal syndrome[J].Mod Pract Med,2024,36:630-632.
[4]杨 培,陈 忠,姜 军,等.影响锁骨下动脉支架远期通畅性的危险因素分析[J].中华医学杂志,2010,90:1739-1742.
Yang P,Chen Z,Jiang J,et al.The analysis to risk factors of affecting the long-term patency ratio of stent planted in arteriosclerosis subclavian artery[J].Natl Med J China,2010,90:1739-1742.
[5]王煜杰,李 震,李明省,等.左锁骨下动脉支架置入术后再狭窄因素分析[J].中国实用医刊,2018,45:1-3.
Wang YJ,Li Z,Li MS,et al.Relative factors of restenosis after left subclavian artery stenting[J].Chin J Pract Med,2018,45:1-3.
[6]武辉林,李 坤,翟水亭,等.锁骨下动脉狭窄和闭塞病变腔内治疗的临床效果[J].河南医学研究,2022,31:2305-2309.
Wu HL,Li K,Zhai ST,et al.Clinical effect of intracavitary therapy for subclavian artery stenosis and occlusion[J].Henan Med Res,2022,31:2305-2309.
[7]孙 勇,杨 波,康开江,等.锁骨下动脉闭塞血管内再通治疗的可行性分析[J].中国卒中杂志,2021,16:940-945.
Sun Y,Yang B,Kang KJ,et al.Feasibility analysis of endovascular recanalization for subclavian artery occlusion[J].Chin J Stroke,2021,16:940-945.
[8]Van Nut L,Vinh PX,Vuong NL.Endovascular treatment for subclavian artery stenosis and occlusion:a single-center retrospective study[J].Cureus,2023,15:e44699.
[9]Wei LB,Gao XX,Tong Z,et al.Outcomes of covered stents versus bare-metal stents for subclavian artery occlusive disease[J].Front Cardiovasc Med,2023,10:1194043.
[10]李秋萍,华 扬,王力力,等.超声评估锁骨下动脉支架植入术后残余狭窄的影响因素[J].中华医学超声杂志(电子版),2018,15:673-678.
Li QP,Hua Y,Wang LL,et al.Evaluation of the influencing factors of residual stenosis after subclavian artery stent placement by ultrasonography[J].Chin J Med Ultrasound Electron Ed,2018,15:673-678.
[11]郭海峰,李 韶,李晓凤,等.锁骨下动脉支架植入术后支架内再狭窄的相关因素分析[J].中风与神经疾病杂志,2017,34:711-713.
Guo HF,Li S,Li XF,et al.The analysis of correlative factors of in-stent restenosis after subclavian artery stent implantation[J].J Apoplexy Nerv Dis,2017,34:711-713.
[12]龚 宇,于 淼,田 甜,等.高分辨率磁共振血管壁成像评估大脑中动脉狭窄斑块特征与支架内再狭窄的相关性[J].介入放射学杂志,2024,33:1282-1287.
Gong Y,Yu M,Tian T,et al.High-resolution magnetic resonance angiography for assessing the correlation between plaque characteristics of middle cerebral artery stenosis and in-stent restenosis[J].J Interv Radiol,2024,33:1282-1287.
[13]杨心志,牛国晨,李鹏宇,等.锁骨下动脉完全闭塞的腔内治疗:单中心回顾性研究[J].中国血管外科杂志(电子版),2024,16:64-67.
Yang XZ,Niu GC,Li PY,et al.Endovascular treatment of total subclavian artery occlusion:a single-center retrospective study[J].Chin J Vasc Surg Electron Version,2024,16:64-67.
[14]陈海杰,徐少华,张 静.基于倾向性得分匹配的吸烟与不吸烟合并心血管疾病的慢阻肺患者的临床特征分析[J].中华健康管理学杂志,2024,18:333-338.
Chen HJ,Xu SH,Zhang J.Clinical characterization of smoking and nonsmoking patients with chronic obstructive pulmonary disease combined with cardiovascular disease based on propensity score matching[J].Chin J Health Manag,2024,18:333-338.
[15]丁乾昊,贺迎坤,赵婧革,等.颅内动脉粥样硬化性狭窄球囊成形术后血管管腔扩张性重构的相关因素分析[J].中华放射学杂志,2024,58:850-858.
Ding QH,He YK,Zhao JG,et al.Analysis of related factors for vascular luminal dilatational remodeling after balloon angioplasty for intracranial atherosclerotic stenosis[J].Chin J Radiol,2024,58:850-858.
[16]梁会珠,马玉良,李 琪,等.冠状动脉斑块旋磨术治疗冠状动脉弥漫钙化病变的长期安全性及有效性[J].中国介入心脏病学杂志,2022,30:814-818.
Liang HZ,Ma YL,Li Q,et al.Long-time outcomes of rotational atherectomy of diffuse calcified coronary artery lesions[J].Chin J Interv Cardiol,2022,30:814-818.
[17]陈 明,王 晶,谭 强.血管内超声评估冠心病合并非酒精性脂肪肝患者支架内再狭窄风险[J].中华实用诊断与治疗杂志,2023,37:771-775.
Chen M,Wang J,Tan Q.Intravascular ultrasonography in in-stent restenosis risk assessment in coronary heart disease patients with non-alcoholic fatty liver disease[J].J Chin Pract Diagn Ther,2023,37:771-775.
[18]Schillinger M,Haumer M,Schillinger S,et al.Risk stratification for subclavian artery angioplasty:is there an increased rate of restenosis after stent implantation?[J].J Endovasc Ther,2001,8:550-557.
[19]陆 赟,翁嘉懿,徐 亮,等.残余胆固醇与低密度脂蛋白胆固醇达标的冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关性[J].中华老年多器官疾病杂志,2024,23:18-22.
Lu B,Weng JY,Xu L,et al.Correlation between remnant cholesterol and in-stent restenosis in coronary heart disease patients with low-density lipoprotein cholesterol compliance after percutaneous coronary intervention[J].Chin J Mult Organ Dis Elder,2024,23:18-22.
(收稿日期:2025-07-25)
(本文编辑:元 禾)

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备注/Memo

备注/Memo:
通信作者: 范昆鹏 E-mail:316307068@qq.com
更新日期/Last Update: 2026-09-25