病程第15天NIHSS评分下降率对老年前循环脑梗死预后的预测价值  

Study on predicting the prognosis of senile anterior circulation cerebral infarction by the reduction rate of NIHSS scores in the first 15 days after onset

作　　者：翟明明 闫俊强 李艺果 杨辉丽 徐锦锦 ZHAI Mingming;YAN Junqiang;LI Yiguo;YANG Huili;XU Jinjin(Clinical Medicine College of Henan University of Science and Technology/The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院,河南洛阳471003

出　　处：《中国实用神经疾病杂志》2020年第24期2170-2175,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省自然科学基金项目(编号:182300410333);国家自然科学基金项目(编号:U1304809)。

摘　　要：目的探讨病程第15天NIHSS评分下降率对老年前循环脑梗死预后的预测价值。方法回顾分析2013-09—2016-09在河南科技大学第一附属医院住院且发病时间在24 h内的438例前循环急性脑梗死老年患者,收集患者发病第1天、第15天时的NIHSS评分并计算脑梗死病程第15天NIHSS评分下降率,根据病程第3个月时的临床预后分为良好临床预后组及非良好临床预后组,对病程第15天NIHSS评分下降率与病程3个月时的临床预后进行相关性分析。结果与非良好临床预后组相比,良好临床预后组糖尿病患病率和全前循环脑梗死比率更低(P<0.05),良好临床预后组腔隙性脑梗死比率和第15天NIHSS评分下降率均更大(P<0.05),良好临床预后组发病第1天NIHSS评分更小(P<0.05)。Logistic回归分析显示,病程第15天NIHSS评分下降率与脑梗死3个月预后密切相关(OR=16.989,95%CI1.102~261.960,P<0.05),ROC曲线分析显示病程第15天NIHSS评分下降率作为3个月临床预后的预测指标,具有良好的敏感性和特异性(敏感度90.4%,特异度90.3%),通过约登指数计算出预测临界值为36.50%。结论结合其他相关因素,病程第15天NIHSS评分下降率可有效用于对老年前循环脑梗死预后的预测。Objective To explore the predictive value of the reduction rate of NIHSS scores in the prognosis of the aged anterior circulation cerebral infarction through retrospective analysis.Methods The 438 elderly patients with anterior circulation cerebral infarction within 24 hours hospitalized in our hospital from september 2013 to september 2016 were analysed retrospectively.The NIHSS scores on the day 1 and 15 after onset were collected,and calculate the reduction rate of NIHSS scores in the first 15 days after onset.Then they were divided into good clinical outcomes and non-good clinical outcomes groups according to the clinical prognosis on the course 3rd month.The correlation between reduction rate of NIHSS scores in the first 15 days after onset and the clinical prognosis on the course 3rd month was analyzed.Results Compared with the non-good clinical outcomes group,the diabetes and the total anterior circulation cerebral infarction rate of the good clinical outcomes group are lower(P<0.05),the lacunar cerebral infarction rate and the reduction rate of NIHSS scores in the first 15 days of the good clinical outcomes group are greater(P<0.05),the NIHSS scores on the day 1 after onset of the good clinical outcomes group is less(P<0.05).Logistic regression analysis showed that the reduction rate of NIHSS scores in the first 15 days is closely related to the prognosis of cerebral infarction for 3 months(OR=16.989,95%CI1.102-261.960,P<0.05).The ROC curve analysis showed that the reduction rate of NIHSS scores in the first 15 days is a independent indicator to 3 months prognosis,and has a good sensitivity and specificity(90.4%,90.3%),and the critical value is 36.50%calculated through youden index.Conclusion Combined with other related factors,the reduction rate of NIHSS scores in the first 15 days can be used to predict the prognosis of senile anterior circulation cerebral infarction effectively.

关 键 词：脑梗死 前循环 NIHSS评分 老年 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]