急性头晕患者中快速识别出脑梗死的评分探索  

Exploring the score for rapid identification of cerebral infarction in patients with acute dizziness

作　　者：林桂名 刘芳芳 闫梦侠 包关水[1,2] LIN Guiming;LIU Fangfang;YAN Mengxia;BAO Guanshui(Department of Neurology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Clinical Research Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属第九人民医院神经内科,上海200011 [2]上海交通大学医学院临床研究中心,上海200025

出　　处：《上海交通大学学报（医学版）》2022年第12期1699-1705,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海吴孟超医学科技基金会(JJHXM-2019009)。

摘　　要：目的·采用改良版TriAGe+评分预测急诊室急性前庭综合征(acute vestibular syndrome,AVS)患者发生脑梗死(cerebral infarction,CI)的可能性,评估改良版Tri AGe+评分的临床应用价值。方法·收集2021年1月1日—2021年8月31日于上海交通大学医学院附属第九人民医院神经内科急诊就诊的AVS患者255例,其中CI患者128例,周围性眩晕患者127例。采用t检验或Mann-Whitney U检验对定量数据进行组间比较,采用χ^(2)检验对定性资料进行组间比较。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC curve,ROC曲线)比较Tri AGe+评分、ABCD^(2)(age,blood pressure,clinical features,duration of symptoms and diabetes)评分、后循环缺血(posterior circulation ischemia,PCI)评分对AVS患者发生CI的预测效果,并计算曲线下面积(area under curve,AUC)。采用多因素Logistic回归研究各种实验室指标对CI的预测作用。之后将Tri AGe+评分与预测CI独立相关的实验室检查相结合形成改良版Tri AGe+评分,并评价该评分预测效果。结果·在2组变量中,脑梗死组男性、高血压、房颤史、无头晕或前庭迷路病史、有头晕症状较周围性眩晕组所占比例高,且差异有统计学意义(均P<0.05)。与ABCD^(2)评分、PCI评分相比,Tri AGe+评分AUC最大(0.859,95%CI0.814~0.904),差异有统计学意义(P=0.000)。多因素Logistic回归结果显示血糖值(P=0.007)和血尿酸值(P=0.008)是预测CI的独立危险因素。当血糖值>7.95 mmol/L显示最佳的AUC,灵敏度为61.7%,特异度为66.1%;当血尿酸值>382.5μmol/L显示最佳AUC,灵敏度为35.2%,特异度为85.0%。当血尿酸值>382.5μmol/L为1分,当血糖值>7.95 mmol/L为1分,将其加入Tri AGe+评分形成改良版Tri AGe+评分,其诊断效果(AUC=0.872,95%CI 0.828~0.915)优于Tri AGe+评分(P=0.007)。当改良版Tri AGe+评分临界值为10.5时,其诊断准确性最佳,灵敏度为81.3%、特异度为80.3%。结论·改良版Tri AGe+评分在识别AVS中CI患Objective·To predict the likelihood of cerebral infarction(CI)in emergency department patients with acute vestibular syndrome(AVS),and to evaluate the clinical value of modified TriAGe+score.Method·Patients with AVS admitted to the Emergency Department of Neurology of Shanghai Ninth People’s Hospital from January 1,2021 to August 31,2021 were collected.There were 128 cases of CI and 127 cases of peripheral vertigo.t test or Mann-Whitney U test was used for inter-group comparison of quantitative data,andχ^(2)test was used for inter-group comparison of qualitative data.Receiver operating characteristic curve(ROC curve)and area under the curve(AUC)were used to compare the prediction effect of TriAGe+score,age,blood pressure,clinical features,duration of symptoms and diabetes score(ABCD^(2) score)and posterior circulation ischemia(PCI)score for CI in patients with AVS.Logistic regression was used to study the influence of laboratory indicators on prediction of CI.The TriAGe+score was then combined with laboratory indicators to formulate improved TriAGe+score.Results·In the two groups of variables,the proportion of male,hypertension,history of atrial fibrillation,no history of dizziness or vestibular labyrinth,and dizziness symptom in CI group was higher than that in peripheral vertigo group,and the difference was statistically significant(all P<0.05).Compared with ABCD^(2) score and PCI score,TriAGe+score had the highest AUC(0.859,95%CI 0.814-0.904),which was statistically significant(P=0.000).Multivariate Logistic regression results showed that blood glucose level(P=0.007)and blood uric acid level(P=0.008)were independent risk factors for predicting CI.When blood glucose level was greater than 7.95 mmol/L,the best AUC showed a sensitivity of 61.7%and specificity of 66.1%.At the same time,serum uric acid value greater than 382.5μmol/L showed the best AUC with sensitivity of 35.2%and specificity of 85.0%.When the blood uric acid value is greater than 382.5μmol/L,it is one point,and when the blood glucose value

关 键 词：脑梗死 卒中 眩晕 头晕 

分 类 号：R741.041[医药卫生—神经病学与精神病学]