脑血管病亚型高危人群的预测量表  

Prediction scale of cerebrovascular disease subtypes for high-risk population

作　　者：严文广[1] 陈茹[2] 胡好 徐嘉苗 郑文[2] 宋治[2] YAN Wenguang;CHEN Ru;HU Hao;XU Jiamiao;ZHENG Wen;SONG Zhi(Department of Rihabilitation Medicine,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Neurology,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院康复医学科,长沙410013 [2]中南大学湘雅三医院神经内科,长沙410013

出　　处：《中南大学学报（医学版）》2022年第7期928-935,共8页Journal of Central South University ：Medical Science

基　　金：supported by the Hunan Provincial Clinical Medical Technology Innovation Guidance Project(2020SK53612);the Natural Science Foundation of Hunan Province(2021JJ30998),China。

摘　　要：目的:脑血管病大致可分为2个亚型,即脑缺血(cerebral ischemia,CI)和脑出血(cerebral hemorrhage,CH),目前还没有可以预测脑血管病亚型的模型。本研究旨在建立一个脑血管疾病亚型的预测模型。方法:本研究共纳入1200名脑血管病患者,其中1081名(90%)患者的数据用于建立CI-CH量表,119名(10%)患者的数据对CI-CH量表进行测试。通过t检验和Fisher’s检验对预测因子进行第1次筛选,利用logistic回归对预测因子进行第2次筛选,以确定CI-CH量表的预测因子;参考OR值确定CI-CH量表的各因子的分值,计算约登指数作为CI-CH量表的分界点。结果:最终选择了9个危险因素作为评分系统,包括年龄(≥75岁为-1;<75岁为0),BMI(24-28 kg/m^(2)为-1,>28 kg/m^(2)为-2),高血压等级(1级为1,2级为2,3级为3),糖尿病(无为0,有为-1),使用降压药物(否为0,是为-2),饮酒量(<60 g/d为1,≥60 g/d为2),尿酸(低于正常为0,正常为-1,高于正常为-2),低密度脂蛋白胆固醇(<2 mmol/L为0,2-4 mmol/L为-1,>4 mmol/L为-2),高密度脂蛋白胆固醇(<1.55 mmol/L为0,≥1.55 mmol/L为2)。得分大于0的患者被归入CH组,反之,被归入CI组;其敏感性、特异性和准确性分别为74.5%、77.9%和76.4%。结论:CI-CH量表可以帮助临床医生预测脑血管疾病的亚型。Objective:Cerebrovascular disease can be roughly divided into 2 subtypes:Cerebral ischemia(CI)and cerebral hemorrhage(CH).No scale currently exist that can predict the subtypes of cerebrovascular diseases.This study aims to establish a prediction scale for the subtypes of cerebrovascular diseases.Methods:A total of 1200 cerebrovascular disease patients were included in this study,data from 1081(90%)patients were used to establish the CI-CH risk scale,and data from 119(10%)patients were used to test it.Risk factors for the CI-CH risk scale were identified by 2 screens,with two-tailed student’s t-test and two-tailed Fisher’s exact test preliminarily and with logistic regression analysis further.The scores of each risk factor for CI-CH risk scale were determined according to the odds rate,and the cut-off point was determined by Youden index.Results:Nine risk factors were ultimately selected for score system,including age(≥75 years old was-1,<75 years old was 0),BMI(<24 kg/m^(2)was 0,24-28 kg/m^(2)was-1,>28 kg/m^(2)was-2),hypertension grade(grade 1 was 1,grade 2 was 2,and grade 3 was 3),diabetes status(no was 0,yes was-1),antihypertensive drug use(no was 0,yes was-2),alcohol consumption(<60 g/d was 1,≥60 g/d was 2),uric acid(less than normal was 0,normal was-1,high than normal was-2),LDL cholesterol(<2 mmol/L was 0,2-4 mmol/L was-1,and>4 mmol/L was-2),and HDL cholesterol(<1.55 mmol/L was 0,≥1.55 mmol/L was 2).Patients with a score more than 0 were classified as the CH group,Conversely,they were assigned to the CI group;its sensitivity,specificity,and accuracy were 74.5%,77.9%,and 76.4%,respectively.Conclusion:The CI-CH risk scale can help the clinician predict the subtypes of cerebrovascular diseases.

关 键 词：脑缺血 脑出血 LOGISTIC回归分析 预测量表 

分 类 号：R743[医药卫生—神经病学与精神病学]