急诊急性缺血性脑卒中患者短期预后预测模型的构建及效能评估  

Construction and efficacy evaluation of a short-term prognostic model for emergency patients with acute ischemic cerebral stroke

作　　者：刘小蒙 李俊玉 何威 王娜[2] 郭树彬[1] 刘慧珍[2] Liu Xiaomeng;Li Junyu;He Wei;Wang Na;Guo Shubin;Liu Huizhen(Emergency Medicine Clinical Research Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China;Department of Emergency Medicine,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊医学临床研究中心,心肺脑复苏北京市重点实验室,北京100020 [2]首都医科大学康复医学院,中国康复研究中心北京博爱医院急诊科,北京100068

出　　处：《中华急诊医学杂志》2024年第1期51-58,共8页Chinese Journal of Emergency Medicine

基　　金：心脑肺复苏北京市重点实验室开放课题(2020XFN-KFKT-01)。

摘　　要：目的建立急诊急性缺血性脑梗死患者14 d不良预后的预测模型,并评价其预测效能。方法采用前瞻性队列研究方法,入选2018年10月至2020年12月就诊北京博爱医院急诊科发病72 h内的急性缺血性脑卒中患者。采用单因素及多因素Logistic回归分析筛选不良预后的影响因素;绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线确定连续型变量的截断值并参考临床进行离散化,根据各变量的β回归系数设立相应分值,建立急性脑梗死短期预后的临床量表预测模型。选取2021年1月至12月本院缺血性脑卒中患者作为内部验证集,对构建的预测评分模型进行验证。结果共321例患者纳入研究,其中223例为训练集,98例为内部训练集。多因素Logistic回归分析显示,年龄、超敏C反应蛋白、前白蛋白(prealbumin,PA)、梗死体积、衰弱筛查问卷(Frailty Screening Questionnaire,FSQ)、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)是急性脑梗死短期预后不良的独立危险因素。构建的急诊急性脑梗死短期预后临床预测评分体系总分为15分,包括:年龄≥74岁(1分)、PA≤373 mg/L(2分)、TOAST中大动脉粥样硬化型(1分)、心源性栓塞型(2分)、梗死体积≥2.18 cm3(2分)、FSQ≥3分(1分)、NIHSS≥4分(6分)。该评分体系预测急性脑梗死短期不良预后的ROC曲线下面积(AUC)为0.927(95%CI:0.894~0.960);最佳截断值为≥5分,其敏感度、特异度分别为0.770、0.976。在内部验证集中,该评分系统对不良预后有相似的预测价值(AUC=0.892,95%CI:0.827~0.957)。结论急性缺血性脑梗死短期预后预测评分体系具有较好的诊断效能,对临床医生早期判断急诊患者预后具有一定指导意义。Objective To establish a 14-day prognosis model for emergency patients with acute ischemic cerebral stroke and evaluate its predictive efficacy.Methods A prospective cohort study was conducted.Patients with acute ischemic stroke admitted to the emergency department of Beijing Bo’ai Hospital within 72 hours of onset from October 2018 to December 2020 were enrolled.Univariate and multivariate logistic regression analysis were used to screen the risk factors of poor prognosis.The ROC curve was drawn to determine the cut-off value of continuous variables and discretise data with reference to clinical practice.The corresponding scores were set up according to theβregression coefficient of each variable,and the clinical scale prediction model of short-term prognosis of acute cerebral infarction was established.Patients with ischemic stroke in the hospital from January to December 2021 were selected as the internal validation,to verify the constructed predictive model.Results A total of 321 patients were included in the study,including 223 in the training set and 98 in the internal validation set.Multivariate logistic regression analysis showed that age,hypersensitive C-reactive protein,prealbumin(PA),infarct volume,Frailty Screening Questionnaire(FSQ)and National Institute of Health Stroke Scale(NIHSS)were independent risk factors for poor short-term prognosis of acute cerebral infarction.The total score of the clinical prediction scoring system for short-term prognosis of acute cerebral infarction in the emergency department was 15 points,including age≥74 years(1 point),PA≤373 mg/L(2 points),large artery atherosclerosis(1 point),cardiogenic embolism(2 points),infarct volume≥2.18 cm3(2 points),FSQ≥3 points(1 point),NIHSS≥4 points(6 points);The area under the ROC curve(AUC)of the scoring system for predicting short-term poor prognosis of acute cerebral infarction was 0.927(95%CI:0.894-0.960).The optimal cut-off value was≥5 points,and the sensitivity and specificity were 0.770 and 0.976,respectively.In the

关 键 词：急性缺血性脑卒中 预测模型 衰弱筛查问卷 

分 类 号：R743.3[医药卫生—神经病学与精神病学]