骨骼肌质量和肌肉力量对缺血性脑卒中患者神经功能的预测效能评价  

Predictive efficacy of skeletal muscle mass and muscle strength on neurological function in patients with ischemic stroke

作　　者：吴登宠[1] 邵湘芝 朱烈烈 WU Dengchong;SHAO Xiangzhi;ZHU Lielie(Department of Rehabilitation,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,China)

机构地区：[1]浙江中医院大学附属温州市中医院康复医学科,浙江温州325000

出　　处：《全科医学临床与教育》2024年第2期128-132,共5页Clinical Education of General Practice

基　　金：温州市基础性科研计划项目(Y20220064);温州市科协服务科技创新项目(jczc153)。

摘　　要：目的 探讨并评价缺血性脑卒中患者骨骼肌质量和肌肉力量对脑卒中后3个月神经功能预后的预测效能。方法 纳入117例缺血性脑卒中患者,根据脑卒中后3个月的改良Rankin量表(mRS)评分分为预后不良组(54例)和预后良好组(63例),比较两组骨骼肌质量、肌肉力量等相关指标的差异。采用Pearson相关分析骨骼肌质量、肌肉力量与mRS评分之间的相关性,采用logistic回归分析ASM/Ht2、握力与神经功能预后之间的关系,同时应用受试者工作特征(ROC)曲线评估其对神经功能预后的预测效能。结果 与预后良好组相比,预后不良组年龄均数较大、国立卫生研究院脑卒中量表(NIHSS)评分均数较高,合并低肌肉质量的患者比例、合并低肌肉力量的患者比例以及同时合并低肌肉质量与低肌肉力量的患者比例均较高;而ASM/Ht2和握力均数则较低,差异均有统计学意义(t分别=3.55、4.94,χ^(2)分别=7.27、20.35、11.51,t分别=-4.40、-9.56,P均<0.05)。ASM/Ht2、握力与mRS评分呈负相关(r分别=-0.56、-0.74,P均<0.05)。多因素logistic回归分析发现,ASM/Ht2和握力大是神经功能预后不良发生的保护因素(OR分别=0.64、0.54,P均<0.05)。ROC分析显示,握力的曲线下面积(AUC)为0.89,明显大于ASM/Ht2的AUC(0.71),差异有统计学意义(Z=3.05,P<0.05)。结论 脑卒中患者发病早期的骨骼肌质量和肌肉力量均与其康复期神经功能不良预后密切相关。骨骼肌质量和肌肉力量对脑卒中患者神经功能预后均具有较好的预测价值,尤其是握力,其预测效能更优。Objective To explore and evaluate the predictive efficacy of skeletal muscle mass and muscle strength in 3-month neurological prognosis in patients with ischemic stroke.Methods A total of 117 stroke patients were included.According to the modified Rankin scale(mRS)score after stroke,all patients were divided into the poor prognosis group(54 cases)and the good prognosis group(63 cases).Skeletal muscle mass and muscle strength were compared between two groups.The correlation between the above indicators and the mRS score was analyzed by pearson correlation.And lo-gistic regression was used to analyze the relationship between ASM/Ht2,grip strength and neurological prognosis,while ap-plying ROC curves to assess their predictive efficacy on neurological prognosis.Results Compared with the good prog-nosis group,the poor prognosis group was older,had a higher median NIHSS score,a higher proportion of patients with low muscle mass,low muscle strength,and both low muscle mass and low muscle strength(t=3.55,4.94,χ^(2)=7.27,20.35,11.51,P<0.05).Meanwhile,there were a lower ASM/Ht2,and a lower grip strength in the poor prognosis group,with sta-tistically significant(t=-4.40,-9.56,P<0.05).After adjusting for age,sex,and BMI,ASM/Ht2 and grip strength were negatively correlated with mRS(r=-0.56,-0.74,P<0.05).Multivariate logistic regression analysis found that both higher ASM/Ht2 and grip strength were in-dependent protective factors for the poor neurologi-cal outcome(OR=0.64,0.54,P<0.05).ROC analysis showed that the AUC of grip strength was the 0.89,which was significantly greater than the AUC of ASM/Ht2(0.71)(Z=3.05,P<0.05).Conclusion The skeletal muscle mass and muscle strength in the ear-ly stage of stroke patients are closely related to their poor neurological prognosis in the rehabilitation period.Both skel-etal muscle mass and muscle strength have a good predictive value for neurological function prognosis in stroke pa-tients,especially for handgrip strength,which has a better predictive efficacy.

关 键 词：脑卒中 四肢肌肉含量 握力 神经功能 康复期 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]