NIHSS评分及D-二聚体早期预测缺血性脑卒中患者大血管闭塞的价值研究  

Baseline NIHSS score and D-dimer in early prediction of large vessel occlusion in patients with acute ischemic stroke

作　　者：张刚[1] 胡德亮[1] 周淑兰 茆丽娜[1] 姜丽丽[1] 张劲松[1] 陈旭锋[1] 王淦楠[1] 蒋雷[1] Zhang Gang;Hu Deliang;Zhou Shulan;Mao Lina;Jiang Lili;Zhang Jinsong;Chen Xufeng;Wang Gannan;Jiang Lei(Department of Emergency Department,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊科,南京210029

出　　处：《中华急诊医学杂志》2023年第2期236-240,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金青年基金(81701872);江苏省六大人才高峰资助项目(WSN-005);江苏省"六个一工程"拔尖人才科研项目(LGY2019068)。

摘　　要：目的早期识别具有大血管闭塞的缺血性脑卒中患者可以提高转诊效率以及缩短再灌注时间,研究的目的是分析大血管闭塞组患者的特征并筛选出其中能够预测大血管闭塞的因素。方法研究回顾性分析了432例经脑卒中绿色通道诊治的缺血性脑卒中患者的临床资料,比较了大血管闭塞组(LVO组)和非大血管闭塞组(非LVO组)之间的差异,并通过Logistic回归分析筛选出LVO组的独立危险因素:基线NIHSS评分和D-二聚体。进一步通过受试者工作特征曲线(ROC曲线)确定NIHSS评分和D-二聚体的预测截断值。结果432例缺血性脑卒中患者具有完整的影像学资料,年龄(68.5±12.4)岁,男性275例(63.7%),其中LVO组245例(56.7%),非LVO组187例(43.3%),两组在年龄、脑梗死出血转化、溶栓治疗、血管内治疗、合并心房颤动、基线NIHSS评分[14.0(6.0~20.0)分vs.3.0(1.0~6.0)分,P<0.05]、入院时D-二聚体值[0.9(0.4~2.3)mg/L vs.0.3(0.2~0.5)mg/L,P<0.05]方面差异有统计学意义。多因素Logistic回归分析显示,基线较高的NIHSS评分(OR=1.22,95%CI:1.17~1.27)和较高的D-二聚体值(OR=3.10,95%CI:2.14~4.47)是大血管闭塞的独立危险因素,基线NIHSS评分联合D-二聚体值对大血管闭塞有较好的预测价值[AUC=0.85(0.81~0.89)]。受试者工作特征曲线提示NIHSS评分>6.5分和D-二聚体>0.57 mg/L是预测大血管闭塞的临界值。结论基线较高的NIHSS评分和D-二聚体值具有早期预测大血管闭塞的价值,NIHSS评分>6.5分及D-二聚体>0.57 mg/L的患者应该及时转诊至高级卒中中心进行治疗。Objective Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time.The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed,and the differences between the large vessel occlusion group(LVO group)and the non-large vessel occlusion group(non-LVO group)were compared,and two independent risk factors of the LVO group were screened out by logistics regression analysis:baseline NIHSS score and D-dimer value.The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic(ROC)curve.Results A total of 432 patients with ischemic stroke had complete imaging data,with a mean age of 68.5±12.4 years,including 275(63.7%)males,and 245(56.7%)in the LVO group and 187(43.3%)in the non-LVO group.Age,hemorrhagic transformation,thrombolytic therapy,endovascular treatment,atrial fibrillation,baseline NIHSS score[14.0(6.0-20.0)vs.3.0(1.0-6.0),P<0.05],and D-dimer value at admission[0.9(0.4-2.3)mg/L vs.0.3(0.2-0.5)mg/L,P<0.05]were statistically significant different between the two groups.Multivariate Logistic regression analysis showed that higher baseline NIHSS score(OR=1.22,95%CI:1.17-1.27)and higher D-dimer value(OR=3.10,95%CI:2.14-4.47)were independent risk factors for large vessel occlusion.Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85[0.81-0.89]).ROC curve suggested that NIHSS score>6.5 and D-dimer>0.57 mg/L were the cutoff values for predicting large vessel occlusion.Conclusions Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion,patients with NIHSS score>6.5 points and D-dimer>0.57 mg/L should be promptly transported to an advanced stroke center for

关 键 词：D-二聚体 NIHSS评分 缺血性脑卒中 大血管闭塞 血管内治疗 溶栓治疗 心房颤动 受试者工作特征曲线 

分 类 号：R743.3[医药卫生—神经病学与精神病学]