基于复合炎症指标联合髂动脉钙化评分预测 下肢动脉术后再狭窄的列线图模型建立与验证

Development and Validation of a Nomogram for Predicting Restenosis after Lower Extremity Arterial Intervention Based on Composite Inflammatory Markers Combined with Iliac Artery Calcification Score

摘要: 目的：探讨复合炎症指标联合髂动脉钙化评分对下肢动脉硬化闭塞症(LEASO)患者腔内治疗后发生再狭窄的预测价值，并构建可视化的列线图预测模型。方法：回顾性纳入2020年1月至2023年12月于合肥市第二人民医院接受腔内治疗的158例LEASO患者，根据术后2年随访期间是否发生再狭窄分为再狭窄组(90例)和非再狭窄组(68例)。收集患者临床资料、实验室检查结果及术前下肢动脉CTA图像，计算髂总动脉和髂外动脉钙化评分以及NLR、PLR、LMR、SII、SIRI、AISI、PAR、CAR、CLR、CALLY、NHR、MHR、LHR、PHR、TyG_index等复合炎症指标。采用单因素及多因素logistic回归分析筛选术后再狭窄的独立危险因素，并构建列线图预测模型。结果：单因素分析显示，中性粒细胞计数(NEU)、血红蛋白(HB)、总胆固醇(TC)、同型半胱氨酸(HCY)、C反应蛋白(CRP)、尿酸(Uric_Acid)、CAR、CLR、CALLY、NHR、髂总狭窄侧、髂总双侧、髂外狭窄侧、髂外双侧钙化评分与再狭窄显著相关(P < 0.1)。多因素logistic回归分析显示，髂外狭窄侧钙化评分(OR = 1.96, 95% CI: 1.32~3.08, P = 0.002)、血红蛋白HB (OR = 0.97，95% CI: 0.95~0.99, P = 0.014)、同型半胱氨酸(HCY) (OR = 1.11, 95% CI: 1.03~1.24, P = 0.030)和中性粒细胞与高密度脂蛋白比值(NHR) (OR = 1.20, 95% CI: 1.02~1.43, P = 0.036)是术后再狭窄的独立危险因素。基于上述4个指标构建的预测模型AUC为0.879 (95% CI: 0.825~0.933)，灵敏度为0.756，特异度为0.868。校准曲线显示模型预测概率与实际观察概率一致性良好(平均绝对误差0.011)，Hosmer-Lemeshow检验P = 0.377。决策曲线分析显示模型在5%~90%阈值范围内具有临床净获益。结论：髂外狭窄侧钙化评分、HB、HCY及NHR是LEASO患者腔内术后再狭窄的独立预测因子，基于此构建的列线图模型具有良好的区分度、校准度及临床实用性，可为临床早期识别高危患者、制定个体化随访方案提供量化工具。

Abstract: Objective: To investigate the predictive value of composite inflammatory markers combined with iliac artery calcification score for restenosis after endovascular treatment in patients with lower extremity arteriosclerosis obliterans (LEASO), and to construct a visual nomogram prediction model. Methods: A retrospective study was conducted on 158 patients with LEASO who underwent endovascular treatment at the Second People’s Hospital of Hefei from January 2020 to December 2023. Patients were divided into restenosis group (n = 90) and non-restenosis group (n = 68) according to whether restenosis occurred during the 2-year follow-up period after surgery. Clinical data, laboratory examination results, and preoperative lower extremity CTA images were collected. Calcification scores of common iliac arteries and external iliac arteries, as well as composite inflammatory markers including NLR, PLR, LMR, SII, SIRI, AISI, PAR, CAR, CLR, CALLY, NHR, MHR, LHR, PHR, and TyG_index were calculated. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative restenosis, and a nomogram prediction model was constructed. Results: Univariate analysis showed that neutrophil count (NEU), hemoglobin (HB), total cholesterol (TC), homocysteine (HCY), C-reactive protein (CRP), uric acid (Uric_Acid), CAR, CLR, CALLY, NHR, calcification scores of stenotic common iliac artery, bilateral common iliac arteries, stenotic external iliac artery, and bilateral external iliac arteries were significantly correlated with restenosis (P < 0.1). Multivariate logistic regression analysis revealed that stenotic external iliac artery calcification score (OR = 1.96, 95% CI: 1.32~3.08, P = 0.002), HB (OR = 0.97, 95% CI: 0.95~0.99, P = 0.014), HCY (OR = 1.11, 95% CI: 1.03~1.24, P = 0.030), and NHR (OR = 1.20, 95% CI: 1.02~1.43, P = 0.036) were independent risk factors for postoperative restenosis. The prediction model based on the above four indicators achieved an AUC of 0.879 (95% CI: 0.825~0.933), with a sensitivity of 0.756 and a specificity of 0.868. The calibration curve showed good consistency between predicted probabilities and actual observed probabilities (mean absolute error 0.011), and the Hosmer-Lemeshow test yielded P = 0.377. Decision curve analysis demonstrated clinical net benefit within the threshold range of 5% to 90%. Conclusion: Stenotic external iliac artery calcification score, HB, HCY, and NHR are independent predictors of restenosis after endovascular treatment in LEASO patients. The nomogram model based on these indicators exhibits good discrimination, calibration, and clinical utility, providing a quantitative tool for early identification of high-risk patients and development of individualized follow-up strategies.