预测大脑中动脉闭塞性脑卒中患者预后的模型建立与验证  

Construction and validation of prognostic model for patients with middle cerebral artery occlusive stroke

作　　者：吴海强 方水桥 徐力[1] 戚进聪 苏瑞林[1] 陈涛[1] WU Hai-qiang;FANG Shui-qiao;XU Li;QI Jin-cong;SU Rui-lin;CHEN Tao(Department of Neurosurgery,Zhanjiang Central People's Hospital,Zhanjiang,Guangdong 524000,China)

机构地区：[1]湛江中心人民医院神经外科,广东湛江524000

出　　处：《中华实用诊断与治疗杂志》2022年第3期271-274,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目(GN-2020R0008);湛江市非资助科技攻关计划项目(2021B101,2020B01271);湛江市科技计划项目(2017A01025)。

摘　　要：目的建立预测大脑中动脉闭塞性脑卒中患者预后的模型,探讨其预测价值。方法大脑中动脉闭塞性脑卒中患者152例,出院12个月改良Rankin评分≥3分或死亡者54例为预后不良组,改良Rankin评分<3分者98例为预后良好组。比较2组性别、年龄、发病至治疗时间、大脑中动脉狭窄程度、美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale, NIHSS)、格拉斯哥昏迷评分、脑卒中病史及血清C反应蛋白(C-reactive protein, CRP)、同型半胱氨酸(hemocysteine, Hcy)等指标;多因素logistic回归分析大脑中动脉闭塞性脑卒中患者预后不良的影响因素;根据多因素logistic回归分析结果,建立预测大脑中动脉闭塞性脑卒中患者预后的列线图模型;绘制ROC曲线,评估预后指数预测大脑中动脉闭塞性脑卒中患者预后的价值。结果预后不良组年龄[(65.33±9.42)岁]大于预后良好组[(59.24±6.52)岁](P<0.05),发病至治疗时间[(5.28±1.11)h]长于预后良好组[(3.65±1.13)h](P<0.05),男性(62.96%)、脑卒中病史(40.74%)、大脑中动脉重度狭窄或闭塞(81.48%)比率及NIHSS[(12.19±5.28)分]、血清CRP水平[(13.51±5.21)mg/L]均高于预后良好组[56.12%、22.47%、20.41%、(10.52±3.45)分、(9.78±2.35)mg/L](P<0.05),格拉斯哥昏迷评分[(8.32±2.98)分]、血清Hcy水平[(13.42±3.98)μmol/L]均低于预后良好组[(9.42±3.15)分、(15.42±4.31)μmol/L](P<0.05),体质量指数,吸烟史及糖尿病、高血压、心绞痛、心肌梗死病史比率,白细胞计数,中性粒细胞计数,淋巴细胞计数,血小板计数,凝血酶原时间及血清高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、三酰甘油水平与预后良好组比较差异均无统计学意义(P>0.05)。年龄(OR=1.138,95%CI:1.057~1.229,P=0.038)、脑卒中病史(OR=2.081,95%CI:1.265~3.657,P=0.012)、发病至治疗时间(OR=4.992,95%CI:3.415~7.239,P=0.015)、大脑中动脉狭窄程度(OR=1.465,95%CI:1.079~2.109,P=Objective To construct the prognostic model of middle cerebral artery occlusive stroke, and to investigate the predictive efficiency. Methods According to the modified Rankin score 12 months after discharge, 152 patients with middle cerebral artery occlusive stroke were divided into 54 patients with Rankin score ≥3 or died(poor prognosis group) and 98 patients with Rankin score <3(good prognosis group). The gender, age, onset-treatment time, severe middle cerebral artery stenosis, National Institutes of Health Stroke Scale(NIHSS) score, Glasgow coma score, stroke history, and the levels of C-reactive protein(CRP) and hemocysteine(Hcy) were compared between two groups. Multivariate logistic regression was done to analyze the influencing factors of poor prognosis of middle cerebral artery occlusive stroke. According to the multivariate logistic regression result, the prognostic prediction model was established. ROC curve was drawn to evaluate the efficiency of prognostic index equation on predicting middle cerebral artery occlusive stroke. Results The patients [(65.33±9.42) years] were older, the onset-treatment time [(5.28±1.11) h] was longer, the percentages of male patients and patients with history of stroke and severe middle cerebral artery stenosis or occlusion(62.96%, 40.74%, 81.48%) were higher, and NIHSS score(12.19±5.28) and serum CRP level [(13.51±5.21) mg/L] were higher in poor prognosis group than those in good prognosis group [(59.24±6.52) years,(3.65±1.13) h, 56.12%, 22.47%, 20.41%, 10.52±3.45,(9.78±2.35) mg/L](P<0.05). Glasgow coma score and serum Hcy level were lower in poor prognosis group[8.32±2.98,(13.42±3.98)μmol/L]than those in good prognosis group[9.42±3.15,(15.42±4.31)μmol/L](P<0.05).There were no significant differences in the body mass index,patients with percentages of diabetes,hypertension,angina pectoris and myocardial infarction,white blood cell count,neutrophil count,lymphocyte count,platelet count,prothrombin time,serum high-density lipoprotein cholesterol,low-density

关 键 词：大脑中动脉闭塞性脑卒中 预后 列线图预测模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]