摘要
目的探讨缺血性卒中风险预测评分(ischemic stroke predictive risk score,iScore)和血清高半胱氨酸(homocysteine,Hcy)对急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的预测价值。方法回顾性纳入2018年7月至2020年6月期间在济宁医学院附属医院住院的急性缺血性卒中患者。END定义为患者入院7 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥2分。应用多变量logistic回归分析确定iScore评分和血清Hcy水平与END的独立相关性,然后应用受试者工作特征(receiver operating characteristics,ROC)曲线评估iScore评分和血清Hcy独立及联合预测END的价值。结果共纳入398例急性缺血性卒中患者,男性241例(60.6%),年龄(65.02±12.17)岁;基线NIHSS评分(12.15±5.67)分,iScore评分(124.58±37.51)分,103例(25.9%)发生END。单变量分析显示,END组与非END组在心房颤动、空腹血糖、血清Hcy、卒中病因学分型(大动脉粥样硬化和小动脉闭塞)、基线NIHSS评分和iScore评分方面均差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,校正年龄、心房颤动、空腹血糖和卒中病因学分型后,iScore评分[优势比(odds ratio,OR)1.016,95%置信区间(confidence interval,CI)1.009~1.040;P=0.004]、血清Hcy(OR 1.191,95%CI 1.075~1.588;P<0.001)以及基线NIHSS评分(OR 1.289,95%CI 1.101~1.613;P=0.023)与END存在显著独立相关性。ROC曲线分析显示,iScore评分与血清Hcy联合预测END的曲线下面积为0.859(95%CI 0.820~0.898;P<0.001),显著高于iScore评分或血清Hcy单独预测(P<0.001)。联合预测的敏感性和特异性分别为81.55%和85.76%。结论iScore评分联合血清Hcy对急性缺血性卒中患者的END具有较高的预测价值。
Objective To investigate the predictive value of the ischemic stroke predictive risk score(iScore)and serum homocysteine(Hcy)for early neurological deterioration(END)in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Affiliated Hospital of Jining Medical University from July 2018 to June 2020 were enrolled retrospectively.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score within 7 d after admission increased by≥2 from the baseline.Multivariate logistic regression analysis was used to determine the independent correlations of iScore and serum Hcy level with END,and then the receiver operating characteristics(ROC)curve was used to evaluate the individual and combined predictive values of iScore and serum Hcy for END.Results A total of 398 patients with acute ischemic stroke were enrolled,including 241(60.6%)males,aged 65.02±12.17 years.The baseline NIHSS score was 12.15±5.67 and iScore was 124.58±37.51,and 103 patients(25.9%)developed END.Univariate analysis showed that there were significant differences in atrial fibrillation,fasting blood glucose,serum Hcy,stroke etiology type(large artery atherosclerosis and small artery occlusion),baseline NIHSS score and iScore between the END group and the non-END group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for age,atrial fibrillation,fasting blood glucose,and stroke etiology type,the iScore(odds ratio[OR]1.016,95%confidence interval[CI]1.009-1.040;P=0.004),serum Hcy(OR 1.191,95%CI 1.075-1.588;P<0.001)and baseline NIHSS score(OR 1.289,95%CI 1.101-1.613;P=0.023)had significant independent correlation with END.ROC curve analysis showed that the area under the curve of iScore combined with serum Hcy for predicting END was 0.859(95%CI 0.820-0.898;P<0.001),which was significantly higher than that of iScore or serum Hcy alone(P<0.001).The sensitivity and specificity of combined prediction were 81.55%and 85.76%,respectively.Conclusion The iScore combined with s
作者
马金凤
王琳
刘丹
于香利
陈芸
徐鹏
Ma Jinfeng;Wang Lin;Liu Dan;Yu Xiangli;Chen Yun;Xu Peng(Department of Neurology,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Neurology,Tengzhou Central People's Hospital,Zaozhuang 277599,China)
出处
《国际脑血管病杂志》
2021年第7期497-502,共6页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
疾病恶化
危险性评估
高半胱氨酸
试验预期值
危险因素
Stroke
Brain ischemia
Disease progression
Risk assessment
Homocysteine
Predictive value of tests
Risk factors
