Essen卒中风险评分对首发缺血性卒中患者第一年复发风险的预测效果分析  

Effect analysis of the Essen stroke risk score on predicting stroke recurrence risk of first-ever ischemic stroke patients within one year

作　　者：严可 杨燕玲 张露[1] 吴晨瑶 蒋敏[1] 朱彩蓉[1] 周沐科[2] Yan Ke;Yang Yanling;Zhang Lu;Wu Chenyao;Jiang Min;Zhu Cairong;Zhou Muke(Department of Epidemiology and Health Statistics,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610061,China)

机构地区：[1]四川大学华西公共卫生学院,四川大学华西第四医院流行病与卫生统计学系,成都610061 [2]四川大学华西医院神经内科

出　　处：《中国脑血管病杂志》2020年第11期648-654,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81673273)。

摘　　要：目的评价Essen卒中风险评分(ESRS)对首发缺血性卒中患者第1年复发的预测效果。方法前瞻性连续收集2010年1月至2018年12月四川大学华西医院神经内科以首发缺血性卒中收入院的患者915例,随访至2019年12月。排除重复纳入3例、空号6例、非缺血性卒中4例、出生日期缺失1例、外周动脉疾病史缺失1例、心脏病史缺失7例、失访109例,最终完成随访者784例纳入本研究。根据ESRS量表,分别对条目中的年龄、有吸烟行为、确诊高血压病、确诊糖尿病、既往心肌梗死病史、确诊其他心脏病(除外心肌梗死和心房颤动)、确诊外周动脉疾病、有短暂性脑缺血发作(TIA)或缺血性卒中病史,共8项条目进行计分,总分为9分。以ESRS<3分与ESRS≥3分,分别将784例总体患者和剔除心房颤动的731例患者分为复发低风险组和复发高风险组。根据改良ESRS量表(删减了年龄、既往心肌梗死病史、外周动脉疾病)的5项条目进行计分,总分为5分。以改良ESRS<2分与改良ESRS≥2分,将784例患者分为复发低风险组和复发高风险组。对完成随访者与失访者的基线特征进行比较;对比分析依ESRS和改良ESRS进行风险分组以及剔除心房颤动患者后按ESRS进行风险分组患者的第1年复发率。采用受试者工作特征(ROC)曲线的曲线下面积(AUC)、敏感度和特异度等指标对ESRS和改良ESRS及剔除心房颤动患者ESRS的预测效果进行评价。考虑到ESRS中低得分条目可能因数据缺失对研究结果与患者真实患病情况产生的偏差,对该类条目进行调整,即按ESRS各条目赋分的总体患者(A组)、对总体患者中有其他心脏病史者的“既往心肌梗死”项全部赋值1分(B组)、对总体患者中“既往TIA史”项全部赋1分(C组),重新计算AUC值,评价ESRS对首发缺血性卒中患者第1年复发的预测效果。AUC比较采用Delong检验。结果(1)首发缺血性卒中患者中,完成随访者与失�Objective To verify whether Essen stroke risk score(ESRS)is able to predict stroke recurrence risk within 1 year after first-ever ischemic stroke.Methods From January 2010 to December 2018,a total of 915 patients with first-ever ischemic stroke were prospectively enrolled in the Department of Neurology of West China Hospital,Sichuan University.Patients were followed up to December 2019.784 cases were finally included in this study after excluding 3 cases of duplication,6 cases of blank number,4 cases of non-ischemic stroke,1 case of missing date of birth,1 case of missing peripheral artery disease history,7 cases of missing heart history and 109 cases of missing follow-up.According to ESRS,8 items including age,smoking,hypertension,diabetes,previous myocardial infarction,other heart diseases(except myocardial infarction and atrial fibrillation),peripheral artery disease,transient ischemic attack(TIA)or ischemic stroke were calculated with a total score of 9.According to ESRS<3 and ESRS≥3,a total of 784 patients and 731 patients excluding atrial fibrillation were divided into low-risk group and high-risk group,respectively.According to the modified ESRS(deleting age,previous history of myocardial infarction,and peripheral artery disease),5 items were calculated with a total score of 5.According to the modified ESRS<2 and≥2,784 patients were divided into low-risk group and high-risk group.The baseline characteristics of patients who completed follow-up and those who lost follow-up were compared;a comparative analysis was made for stroke recurrence risk prediction within 1 year after first-ever stroke in patients grouped according to ESRS and modified ESRS,and in those excluded of atrial fibrillation according to ESRS.The area under the curve(AUC)of receiver operating characteristic(ROC)curve,sensitivity and specificity were used to evaluate the predictive ability of ESRS,modified ESRS and ERAS in patients with atrial fibrillation exclusion.Considering deviation between research results and patients′real condi

关 键 词：Essen卒中风险评分 缺血性卒中 卒中复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学]