Research Progress on the Application of Markov Models in Clinical Decision-Making for Stroke

doi:10.3969/j.issn.1673-5765.2025.08.010

Abstract

Abstract: Stroke has a long course and is affected by multiple factors. In-depth exploration of the effects of different intervention measures on the disease course and prognosis can provide critical evidence for developing precision intervention strategies. The Markov model, by calculating the probabilities of state transitions in a disease over a certain period, can effectively simulate disease progression and clearly compare the effects of different intervention measures across various stages, thereby enhancing the precision in predicting stroke prognosis and improving its outcomes. Based on these advantages, this study reviews the definition, principles, and construction methods of Markov models and their applications in stroke clinical decision-making, aiming to provide valuable insights for related research in China.

Key words: Stroke; Markov model; Clinical decision-making

摘要： 卒中病程较长且受多种因素共同影响，深入探究不同干预措施对其病程和预后的作用，可为精准化卒中干预策略的制订提供重要依据。马尔可夫模型能够计算疾病在一定时期内的状态转移概率，模拟疾病的发展过程，并清晰比较各个病程阶段下不同干预措施的效果，助力卒中预后结局的精准预测与改善。基于此，本研究综述了马尔可夫模型的定义、原理、构建方法及其在卒中临床决策研究中的应用情况，以期为国内相关研究提供有益思路。

关键词: 卒中; 马尔可夫模型; 临床决策

CLC Number:

HUANG Xinying, KE Jiawen, LU Zuolin, JIANG Yong, SHAO Ruitai. Research Progress on the Application of Markov Models in Clinical Decision-Making for Stroke[J]. Chinese Journal of Stroke, 2025, 20(8): 1013-1021.

黄馨莹, 柯嘉雯, 陆作林, 姜勇, 邵瑞太. 卒中临床决策中马尔可夫模型的应用研究进展[J]. 中国卒中杂志, 2025, 20(8): 1013-1021.

References

[1] WANG Y J，LI Z X，GU H Q，et al. China stroke statistics 2019：a report from the National Center for Healthcare Quality Management in Neurological Diseases，China National Clinical Research Center for Neurological Diseases，the Chinese Stroke Association，National Center for Chronic and Non-communicable Disease Control and Prevention，Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J]. Stroke Vasc Neurol，2020，5（3）：211-239.
[2] MA Q F，LI R，WANG L J，et al. Temporal trend and attributable risk factors of stroke burden in China，1990-2019：an analysis for the global burden of disease study 2019[J/OL]. Lancet Public Health，2021，6（12）：e897-e906[2025-01-15]. https://doi.org/10.1016/S2468-2667 (21) 00228-0.
[3] 彭琴. 基于决策树-马尔科夫模型的脑卒中筛查策略的卫生经济学评价[D]. 天津：天津医科大学，2020.
PENG Q. Health economic evaluation of stroke screening strategy using decision tree Markov model[D]. Tianjin：Tianjin Medical University，2020.
[4] 易华云，刘爱忠，张琰. Markov模型在卫生领域中应用简介[J]. 循证医学，2008，8（3）：172-176.
YI H Y，LIU A Z，ZHANG Y. The application of Markov model in health field[J]. The Journal of Evidence-Based Medicine，2008，8（3）：172-176.
[5] SONNENBERG F A，BECK J R. Markov models in medical decision making：a practical guide[J]. Med Decis Making，1993，13（4）：322-338.
[6] LIU Q P，GAO P，TANG X，et al. Applications of Markov model for cost-effectiveness analysis of screening in epidemiology[J]. Chin J Epidemiol，2021，42（4）：728-734.
[7] BRIGGS A，SCULPHER M. An introduction to Markov modelling for economic evaluation[J]. Pharmacoeconomics，1998，13（4）：397-409.
[8] MOREIRA C，MEIRA-MACHADO L，FONSECA M J，et al. A multistate model for analyzing transitions between body mass index categories during childhood：the generation ⅩⅪ birth cohort study[J]. Am J Epidemiol，2019，188（2）：305-313.
[9] 杨珊珊，李新毅，周立业，等. 基于多状态Markov模型的老年人认知损害转归研究[J]. 中国卫生统计，2012，29（4）：516-519.
YANG S S，LI X Y，ZHOU L Y，et al. Outcome predition of mild cognitive impairment based on multi-state Markov model[J]. Chinese Journal of Health Statistic，2012，29（4）：516-519.
[10] BECK J R，PAUKER S G. The Markov process in medical prognosis[J]. Med Decis Making，1983，3（4）：419-458.
[11] YANG J Q，CHEN L K，CHITKARA N，et al. A Markov model to compare the long-term effect of aspirin，clopidogrel and clopidogrel plus aspirin on prevention of recurrent ischemic stroke due to intracranial artery stenosis[J]. Neurol India，2014，62（1）：48-52.
[12] WANG Y L，PAN Y S，ZHAO X Q，et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack（CHANCE）trial：one-year outcomes[J]. Circulation，2015，132（1）：40-46.
[13] 刘丽萍，陈玮琪，段婉莹，等. 中国脑血管病临床管理指南（节选版）——缺血性脑血管病临床管理[J]. 中国卒中杂志，2019，14（7）：709-725.
LIU L P，CHEN W Q，DUAN W Y，et al. Chinese stroke association guidelines for clinical management of cerebrovascular diseases（excerpt）—clinical management of ischaemic cerebrovascular diseases[J]. Chin J Stroke，2019，14（7）：709-725.
[14] SHEN Y J，HU M Y，CHEN Q L，et al. Comparative effectiveness of different combinations of treatment interventions in patients with stroke at the convalescence stage based on the Markov decision process[J/OL]. Evid Based Complement Alternat Med，2020，2020：8961341[2025-01-15]. https://doi.org/10.1155/2020/8961341.
[15] BERKOWITZ A L，WESTOVER M B，BIANCHI M T，et al. Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings[J]. Neurology，2014，83（11）：1004-1011.
[16] ISLEK D，SOZMEN K，UNAL B，et al. Estimating the potential contribution of stroke treatments and preventative policies to reduce the stroke and ischemic heart disease mortality in Turkey up to 2032：a modelling study[J/OL]. BMC Public Health，2016，16：46[2025-01-15]. https://doi.org/10.1186/s12889-015-2655-8.
[17] SAIDI O，O’FLAHERTY M，ZOGHLAMI N，et al. Comparing strategies to prevent stroke and ischemic heart disease in the Tunisian population：Markov modeling approach using a comprehensive sensitivity analysis algorithm[J/OL]. Comput Math Methods Med，2019，2019：2123079[2025-01-15]. https://doi.org/10.1155/2019/2123079.
[18] CHAMBERS M G，KOCH P，HUTTON J. Development of a decision-analytic model of stroke care in the United States and Europe[J]. Value Health，2002，5（2）：82-97.
[19] MALHOTRA A，WU X，PAYABVASH S，et al. Comparative effectiveness of endovascular thrombectomy in elderly stroke patients[J]. Stroke，2019，50（4）：963-969.
[20] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. 2018 guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2018，49（3）：e46-e110[2025-01-15]. https://doi.org/10.1161/STR.0000000000000158.
[21] KUNZ W G，HUNINK M G，DIMITRIADIS K，et al. Cost-effectiveness of endovascular therapy for acute ischemic stroke：a systematic review of the impact of patient age[J]. Radiology，2018，288（2）：518-526.
[22] EMBERSON J，LEES K R，LYDEN P，et al. Effect of treatment delay，age，and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke：a meta-analysis of individual patient data from randomised trials[J]. Lancet，2014，384（9958）：1929-1935.
[23] HAN M Y，QIN Y K，TONG X，et al. Cost-effective analysis of mechanical thrombectomy alone in the treatment of acute ischaemic stroke：a Markov modelling study[J/OL]. BMJ Open，2022，12（4）：e059098[2025-01-15]. https://doi.org/10.1136/bmjopen-2021-059098.
[24] YANG P F，ZHANG Y W，ZHANG L，et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke[J]. N Engl J Med，2020，382（21）：1981-1993.
[25] ZHAO S F，CHENG Y H，TONG X，et al. Cost-effectiveness of recombinant tissue-type plasminogen activator for acute ischaemic stroke with unknown time of onset：a Markov modelling analysis from the Chinese and US perspectives[J/OL]. BMJ Open，2022，12（11）：e065133[2025-01-15]. https://doi.org/10.1136/bmjopen-2022-065133.
[26] WETMORE J B，PHADNIS M A，ELLERBECK E F，et al. Relationship between stroke and mortality in dialysis patients[J]. Clin J Am Soc Nephrol，2015，10（1）：80-89.
[27] XIE X H，STRICKLER H D，XUE X N. Additive hazard regression models：an application to the natural history of human papillomavirus[J/OL]. Comput Math Methods Med，2013，2013：796270[2025-01-15]. https://doi.org/10.1155/2013/796270.
[28] DABROWSKA D M，SUN G W，HOROWITZ M M. Cox regression in a Markov renewal model：an application to the analysis of bone marrow transplant data[J]. Journal of the American Statistical Association，1994，89（427）：867-877.
[29] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2020（中文版）（1）[J]. 中国卒中杂志，2022，17（5）：433-447.
WANG Y J，LI Z X，GU H Q，et al. China stroke statistics 2020（1）[J]. Chin J Stroke，2022，17（5）：433-447.
[30] MIJAJLOVIĆ M D，PAVLOVIĆ A，BRAININ M，et al. Post-stroke dementia—a comprehensive review[J/OL]. BMC Med，2017，15（1）：11[2025-01-15]. https://doi.org/10.1186/s12916-017-0779-7.