V_(1)导联P波终末电势联合洛桑评分对缺血性卒中不良功能预后的预测价值  

The predictive value of combining P-wave terminal force in lead V_(1)with ASTRAL score for poor functional prognosis in patients with ischemic stroke

作　　者：裴璐璐 柴源 杨钧哲 刘凯[1] 刘晗 张定 赵召阳 周懿芳 陈子昕 许予明[1] 宋波[1] Pei Lulu;Chai Yuan;Yang Junzhe;Liu Kai;Liu Han;Zhang Ding;Zhao Zhaoyang;Zhou Yifang;Chen Zixin;Xu Yuming;Song Bo(Department of Neurology,The First Affiliated Hospital of Zhengzhou University,Henan Key Laboratory of Cerebrovascular Diseases,The NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease,Zhengzhou 450000,China;Department of Neurology,Xinyang Central Hospital,Xinyang 464000,China)

机构地区：[1]郑州大学第一附属医院神经内科、河南省脑血管病重点实验室、国家卫生健康委脑血管病防治重点实验室(共建),郑州450000 [2]信阳市中心医院神经内科,信阳464000

出　　处：《中华心律失常学杂志》2024年第1期57-63,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：河南省自然科学基金杰出青年科学基金(212300410017);河南省卫生健康科技创新领军人才培养项目(YXKC2020019)。

摘　　要：目的探讨V_(1)导联P波终末电势(PTFV_(1))联合洛桑(ASTRAL)评分对急性缺血性卒中患者不良功能预后的预测价值。方法本研究是前瞻性队列研究,连续纳入2019年1月至2021年12月于郑州大学第一附属医院住院的发病7 d内的缺血性卒中患者。收集患者基线信息,测量患者PTFV_(1),计算ASTRAL评分。结局事件为1年不良功能预后(改良Rankin评分>2分)。通过建立Logistic回归模型,分析PTFV_(1)对不良功能预后的预测价值。将PTFV_(1)加入ASTRAL评分,拟合P-ASTRAL评分。通过绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),验证模型的预测价值。结果最终纳入3399例患者,年龄(59±12)岁,年龄范围14~95岁。其中男占70.3%(2390/3399),PTFV_(1)增大的比例为8.8%(299/3399)。与改良Rankin评分≤2分的患者相比,功能预后不良患者年龄更大(t=12.40,P<0.001)、男性更多(χ^(2)=23.85,P<0.001)、有更多的危险因素[糖尿病(χ^(2)=5.54,P=0.019)、既往卒中病史(χ^(2)=56.38,P<0.001)、冠心病(χ^(2)=22.72,P<0.001)]、PTFV_(1)增大的比例更多(χ^(2)=229.65,P<0.001)及ASTRAL评分更高(χ^(2)=424.02,P<0.001)。矫正混杂因素后,PTFV_(1)增大(OR=4.168,95%CI 3.101~5.602,P<0.001)及ASTRAL评分增加(OR=1.122,95%CI 1.097~1.148,P<0.001)是会增加1年不良功能结局的风险。ASTRAL评分对1年不良功能预后的预测价值高于ASTRAL评分(AUC:0.753对0.739,Z=2.317,P=0.021)。结论PTFV_(1)是缺血性卒中患者不良预后的危险因素,P-ASTRAL评分可以提高对缺血性卒中不良结局的预测价值。Objective To investigate the predictive value of adding P-wave terminal force in lead V_(1)(PTFV_(1))to ASTRAL score for poor functional prognosis in patients with acute ischemic stroke.Methods The study was a prospective cohort study.The hospitalized ischemic stroke patients within 7 days of onset from January 2019 to December 2021 in The First Affiliated Hospital of Zhengzhou University were enrolled.The baseline characteristics were collected,the values of PTFV_(1)were measured,and ASTRAL scores were evaluated.The unfavorable outcome was defined as 1-year modified Rankin Scale score(mRS)>2.Logistic regression model was conducted to determine the association of PTFV_(1)with unfavorable outcome.P-ASTRAL score was established by adding PTFV_(1)to ASTRAL score.The receiver operating characteristics(ROC)curves were plotted,and areas under the curves(AUC)were calculated to evaluate the prognostic significance.Results A total of 3399 acute stroke patients were enrolled.The average age were(59±12)years old(range:16-95 years),70.3%(2390/3399)of patients were male,8.8%(299/3399)patients had an increased PTFV_(1)value.In comparison with patients with mRS≤2,patients with poor functional outcome were much older(t=12.40,P<0.001),had a higher proportion of male(χ^(2)=23.85,P<0.001),had much more risk factors[diabetes mellitus(χ^(2)=5.54,P=0.019),stroke history(χ^(2)=56.38,P<0.001),coronary heart disease(χ^(2)=22.72,P<0.001)],had a higher proportion of increased PTFV_(1)value(χ^(2)=229.65,P<0.001),and higher ASTRAL score(χ^(2)=424.02,P<0.001).After adjusting confounding factors,PTFV_(1)>5000μV·ms(OR=4.168,95%CI 3.101-5.602,P<0.001)and ASTRAL score(OR=1.122,95%CI 1.097-1.148,P<0.001)could increased the risk of 1-year poor functional outcome.The AUC for P-ASTRAL score was higher than ASTRAL score(0.753 vs.0.739,Z=2.317,P=0.021).Conclusion PTFV_(1)was an independent risk factor of unfavorable outcome for stroke.P-ASTRAL score could improve the predictive value of poor functional outcome for ischemic stroke.

关 键 词：卒中 V_(1)导联P波终末电势 洛桑评分 预测价值 不良预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]