院前量表预测急性缺血性卒中患者的大血管闭塞:10种量表比较  

Prehospital scales predict large vessel occlusion in patients with acute ischemic stroke:a comparison of 10 scales

作　　者：陈舒敏 周俊明[2] 刘光辉[1] 张永芳 李玲[1] 张海军 周亮[1] Chen Shumin;Zhou Junming;Liu Guanghui;Zhang Yongfang;Li Ling;Zhang Haijun;Zhou Liang(Department of Neurology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Continuing Education,the First People's Hospital of Foshan,Foshan 528000,China;Department of Neurology,Baoan District People's Hospital,Shenzhen 518101,China)

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]佛山市第一人民医院继续教育科,528000 [3]深圳市宝安区人民医院神经内科,518101

出　　处：《国际脑血管病杂志》2019年第11期807-813,共7页International Journal of Cerebrovascular Diseases

基　　金：广东省自然科学基金(2017A030313622);广州市科技计划(201804010446);南方医院院长基金(2016B017)。

摘　　要：目的比较10种院前评估量表对急性缺血性卒中患者大血管闭塞的预测价值。方法回顾性纳入2016年1月至2018年12月南方医科大学南方医院神经内科收治的发病24 h内的急性缺血性卒中患者。依据临床资料计算各种量表得分,包括美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、洛杉矶运动量表(Los Angeles Motor Scale,LAMS)、3项内容卒中量表(3-item stroke scale,3I-SS)、院前急性卒中严重程度量表(Prehospital Acute Stroke Severity scale,PASS)、临床急诊分流评估量表(Ambulance Clinical Triage For Acute Stroke Treatment,ACT-FAST)和卒中视野、失语、忽视评估量表(the stroke Vision,Aphasia,Neglect assessment,VAN)等。确定NIHSS评分预测阈值,采用受试者工作特征(receiver operator characteristic,ROC)曲线和曲线下面积(area under the curve,AUC)评估各种院前量表预测大血管闭塞的效能。结果共纳入705例发病24 h内的急性缺血性卒中患者,其中252例(35.7%)存在大血管闭塞。NIHSS评分判断大血管闭塞的最佳预测截断值为9分,敏感性为81.7%,特异性为79.7%,阳性似然比为4.851,阴性似然比为0.260。LAMS评分≥4分(敏感性88.1%,特异性81.0%,阳性似然比4.640,阴性似然比0.247)、VAN阳性(敏感性83.7%,特异性82.3%,阳性似然比4.741,阴性似然比0.198)和NIHSS评分≥9分识别大血管闭塞的准确性较高。8种定量评分的AUC值均>0.7,其中LAMS的AUC最大(0.852,95%可信区间0.825~0.878)。结论在发病24 h内的急性缺血性卒中患者中,NIHSS评分≥9分可作为预测大血管闭塞事件的最佳截断值。LAMS、VAN和NIHSS量表预测大血管闭塞的准确性均较高。8种定量量表的预测效能均较高,其中LAMS的AUC最大,可用于急性缺血性卒中患者大血管闭塞的临床预测。Objective To compare the predictive value of 10 prehospital assessment scales for large vessel occlusion in patients with acute ischemic stroke.Methods From January 2016 to December 2018,patients with acute ischemic stroke within 24 h of onset admitted to the Department of Neurology,Nanfang Hospital,Southern Medical University were enrolled retrospectively.The scores of various scales were calculated based on clinical data,including the National Institutes of Health Stroke Scale(NIHSS),Los Angeles Motor Scale(LAMS),and 3-item stroke scale(3I-SS),Prehospital Acute Stroke Severity Scale(PASS),Ambulance Clinical Triage For Acute Stroke Treatment(ACT-FAST),and Stroke Vision,Aphasia,and Neglect Assessment Scales(VAN),etc.The predictive threshold of the NIHSS score was determined,and the receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to evaluate the effectiveness of various prehospital scales to predict large vessel occlusion.Results A total of 705 patients with acute ischemic stroke within 24 h of onset were enrolled,including 252(35.7%)with large vessel occlusion.The best predictive cutoff value for judging large vessel occlusion by the NIHSS score was 9,sensitivity was 81.7%,specificity was 79.7%,positive likelihood ratio was 4.851,and negative likelihood ratio was 0.260.LAMS score≥4(sensitivity 88.1%,specificity 81.0%,positive likelihood ratio 4.640,and negative likelihood ratio 0.247),VAN positive(sensitivity 83.7%,specificity 82.3%,positive likelihood ratio 4.741,and negative likelihood ratio 0.198)and NIHSS score≥9 were more accurate in identifying large vessel occlusion.The AUC values of the 8 quantitative scores were all>0.7,and the AUC of LAMS was the largest(0.852,95%confidence interval 0.825-0.878).Conclusions In patients with acute ischemic stroke within 24 h of onset,the NIHSS score≥9 can be used as the best cutoff value for predicting large vessel occlusion events.LAMS,VAN,and NIHSS scales are more accurate in predicting large vessel occlusion.The predictive

关 键 词：卒中 脑缺血 疾病严重程度 动脉闭塞性疾病 试验预期值 敏感性与特异性 

分 类 号：R74[医药卫生—神经病学与精神病学]