基于磁共振成像特征的预测模型对中枢性卒中后疼痛风险的预测价值  

The Predictive Value of the Prediction Model Based on MRI Features for the Risk of Pain After Central Stroke

作　　者：郭治平[1] 段大兵 朱学文 尹世更 Guo Zhiping;Duan Dabing;Zhu Xuewen;Yin Shigeng(Zhengzhou First People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第一人民医院,郑州450000

出　　处：《健康教育与健康促进》2020年第3期260-263,269,共5页Health Education and Health Promotion

摘　　要：目的研究分析脑卒中患者中枢性卒中后疼痛(CPSP)发生情况及其与磁共振成像的相关性。方法选取2018年1月—2019年1月于郑州市第一人民医院神经内科确诊为中枢性卒中后疼痛的脑卒中患者36例为CPSP组,同期无中枢性卒中后疼痛的脑卒中患者60例为对照组,分析两组患者的病程、美国国立卫生院卒中量表(NIHSS)评分、简化Mc Gill疼痛问卷(SFMPQ)评分、血液相关指标、磁共振成像结果等情况。结果两组患者的卒中病程、SF-MPQ评分、血红蛋白、甘油三酯、总胆固醇、空腹血糖水平无显著性差异(P>0.05);CPSP组的NIHSS评分(t=3.694,P=0.000)、低密度脂蛋白水平(t=2.396,P=0.019)、糖化血红蛋白水平(t=2.234,P=0.028)显著高于对照组;两组患者卒中类型、病灶数量、脑白质脱髓鞘情况的差异无统计学意义(P>0.05);两组患者的卒中面积(χ2=4.384,P=0.036)、卒中部位(χ2=14.863,P=0.001)差异有统计学意义。logistic回归分析显示,NIHSS评分水平(OR=1.343,P=0.039)、糖化血红蛋白(OR=3.390,P=0.008)、病灶数量(OR=9.032,P=0.005)、丘脑卒中(OR=27.804,P=0.007)为中枢性卒中后疼痛的危险因素;列线图预测复发发生的一致性指数(C-index)为0.906(95%CI:0.850~0.961)。结论 NIHSS评分升高、糖化血红蛋白升高、多发病灶、丘脑卒中等危险因素构件的列线图可有效预测脑卒中后中枢性卒中后疼痛,并具有较好的应用价值。Objective To analyze the incidence of central post-stroke pain(CPSP)in stroke patients and its correlation with magnetic resonance imaging.Methods From January 2018 to January 2019,36 stroke patients diagnosed as central post-stroke pain in neurology department of Zhengzhou First People’s Hospital were selected as CPSP group,and 60 stroke patients without central post-stroke pain in the same period were selected as control group.The course,score of NIH Stroke Scale(NIHSS)and Short-form McGill Pain Questionnaire(SF-MPQ),blood related indicators,and MRI results were analyzed.Results There was no significant difference in the course of stroke,SF-MPQ score,hemoglobin,triglyceride,total cholesterol and fasting blood glucose between the two groups(P>0.05);NIHSS score(t=3.694,P=0.000),low-density lipoprotein level(t=2.396,P=0.019),glycosylated hemoglobin level(t=2.234,P=0.028)in the CPSP group were significantly higher than those in the control group;there was no significant difference in stroke type,number of lesions,and demyelination of white matter between the two groups(P>0.05);there were significant differences in stroke area(χ2=4.384,P=0.036)and stroke location(χ2=14.863,P=0.001)between the two groups.logistic regression analysis showed that NIHSS score(OR=1.343,P=0.039),glycosylated hemoglobin(OR=3.390,P=0.008),number of lesions(OR=9.032,P=0.005),thalamic stroke(OR=27.804,P=0.007)were the risk factors of post-stroke pain;C-index predicted by nomogram was 0.906(95%CI:0.850-0.961).Conclusion The nomogram of NIHSS score,glycosylated hemoglobin,multiple lesions and thalamic stroke medium risk factors can effectively predict the post-stroke pain of central stroke,and has good application value.

关 键 词：脑卒中 中枢性卒中后疼痛 磁共振成像 丘脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]