GCS和NIHSS对基底动脉尖综合征临床转归的预测  

Prognostic value of GCS and NIHSS in patients with acute top of basilar syndrome

作　　者：翟登月[1,2] 魏宁[1,2] 吴波娜[1,2] 卢婷婷[1,2] 刘文华[1,2] 高海宁[1,2] 陈兆耀[1,2] 徐格林[1,2] 刘新峰[1,2] 

机构地区：[1]南方医科大学南京临床学院 [2]南京军区南京总医院神经内科,南京210002

出　　处：《中国神经精神疾病杂志》2010年第3期141-144,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：江苏省自然科学基金资助项目(编号:BK2008324)

摘　　要：目的探讨格拉斯哥昏迷评分（Glasgow Coma Scale,GCS）及美国国立卫生院神经功能缺损评分（National Institutes of Health Stroke Scale,NIHSS）对基底动脉尖综合征（top of the basilar syndrome,TOBS）转归的预测价值。方法从南京卒中注册系统中筛选出符合基底动脉尖综合征诊断的64例患者,根据卒中后30d改良Rankin量表评分（modified Rankin Scale,mRS）分为好转组（0-3分）和不良转归组（4-6分）,对两组入院时GCS、NIHSS评分进行回顾性分析。结果不良转归组中GCS分值低于好转组（P〈0.01）;NIHSS分值均高于好转组（P=0.011）。经Logistic回归校正年龄、性别及治疗方式3个因素后,GCS评分OR值0.301（95%CI0.167-0.542）;NIHSS评分OR值1.436（95%CI1.147-1.796）,二者均为独立预测因素。ROC曲线分析显示,以GCS分值10分作为预测TOBS预后的界点,其灵敏度87.9%,特异度83.9%;以NIHSS分值14分作为界点,灵敏度63.6%,特异度77.4%。结论GCS、NIHSS均是基底动脉尖综合征转归重要的预测指标;GCS≤10分、NIHSS≥14分对于基底动脉尖综合征患者不良转归均有重要的预测价值,GCS预测效价高于NIHSS。Objective To assess the effectiveness of initial Glasgow Coma Scale（GCS）and National Institutes of Health Stroke Scale（NIHSS）as predictors for clinical outcomes in patients with top of the basilar syndrome（TOBS）.Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program（NSRP）.Initial GCS and NIHSS were retrospectively evaluated by reviewing patients＇ records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale（mRS）score.Patients were categorized as favorable outcome group（mRS 0-3）and unfavorable outcome group（mRS 4-6）.Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3（P0.01）and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group（P=0.011）.In multivariate logistic regression analysis,after adjusting for age,gender and treatment approaches,the GCS OR was 0.301（95% CI 0.167-0.542）,NIHSS OR was 1.436（95% CI 1.147-1.796）,and both of them turned out to be the independent predictors of outcome at 30 days.ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%.NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome.GCS cutoff point is more strongly predictive of outcome than that of NIHSS.

关 键 词：基底动脉尖综合征 GCS NIHSS 预测值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]