脑血管功能积分和改良弗明汉卒中风险积分预测效能对比研究  

Comparison between Cerebrovascular Function Score and Modified Framingham Stroke Profile for stroke prediction

作　　者：刘广西[1] 王艳[1] 郭吉平[1] 顾桢茂[1] 李学松[1] 黄久仪[1] LIU Guangxi;WANG Yan;GUO Jiping;GU Zhenmao;LI Xuesong;HUANG Jiuyi(Community Prevention Department,Shanghai Institute of Cerebrovascular Disease Prevention,Shanghai 200063,China)

机构地区：[1]上海市脑血管病防治研究所社区预防室,上海200063

出　　处：《中国慢性病预防与控制》2024年第5期349-352,共4页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：国家自然科学基金(30771851,81573248)。

摘　　要：目的对比脑血管功能积分(CVFS)和改良弗明汉卒中风险积分量表(MFSP)评估10年首发卒中风险的效能,为首发卒中风险评估工具的选择提供参考。方法2003年4月,以整群抽样的方法在上海市奉贤区某社区建立了40岁及以上人群卒中危险因素研究队列,共计7489人纳入研究。以统一的调查表对卒中常见危险因素进行基线调查,同时进行脑血管功能指标检测和心电图检测。逐年随访卒中的发病情况,首发卒中作为观察终点,随访时间截至2014年12月31日。评估和比较CVFS和MFSP预测10年首发卒中风险的效能。采用SPSS 17.0软件进行趋势χ^(2)检验。结果7489名调查对象平均随访(10.6±1.5)年,随访期间共发生首发卒中225例。随着CVFS的降低和MFSP积分的升高,男女性首发卒中风险均呈上升趋势(P<0.01)。MFSP预测男性首发卒中的概率明显高于实际卒中发病率,预测的敏感度、特异度、受试者工作特征(ROC)曲线下面积(AUC)分别为97.0%、17.6%和0.757。女性MFSP积分值<15分者预测首发卒中的概率与实际发病率接近,但积分值≥15分者卒中的预测概率明显高于实际发病率,预测的敏感度、特异度、AUC分别为58.1%、78.3%和0.769。除男性31~40和0~10分段,CVFS预测男、女性首发卒中的概率与实际发病率比较接近。预测男性首发卒中的敏感度、特异度、AUC分别为56.4%、76.4%和0.682,女性分别为60.5%、70.9%和0.709。CVFS与MFSP预测男性卒中高危人群的符合率为39.5%,Kappa值为0.09,预测女性卒中高危人群的符合率为74.1%,Kappa值为0.34。结论CVFS预测男、女首发卒中风险与实际发病率接近,MFSP明显高估男性和高分值段女性国人首发卒中风险。Objective To compare and evaluate the Cerebrovascular Function Score(CVFS)and Modified Framingham Stroke Profile(MFSP)for assessing 10 year risk of first stroke,and provide the reference for the selection of the first stroke risk assessment tools.Methods In April 2003,the cluster sampling method was used to establish a cohort for stroke risk factors including 7489 subjects(≥40 years old)from a community in Fengxian District of Shanghai.The baseline investigation for common stroke risk factors was performed with the indexes of cerebrovascular function and electrocardiogram(ECG).The incidence of stroke was followed up year by year,the first stroke served as the end point,and the follow-up was until December 31,2014.The efficacy of CVFS and MFSP in predicting 10-year first-episode stroke risk was evaluated and compared.The trend χ^(2) test was used to analyze the data.The used software was SPSS 17.0.Results Mean follow-up time of 7489 subjects was(10.6±1.5)years.During the follow-up period,225 cases suffered from the first stroke.With the MFSP score increase and the CVFS reduction,the risk of first stroke in males and females significantly increased(P<0.01).MFSP predicted that the probability of first stroke in males was significantly higher than actual stroke incidence,the predicted sensitivity,specificity,and area under the receiver operating characteristic(ROC)curve(AUC)were 97.0%,17.6%,and 0.757,respectively.The probability of female MFSP score<15 predicting first stroke was close to the actual incidence,but the probability of female MFSP score≥15 predicting first stroke was significantly higher than actual stroke incidence,the predicted sensitivity,specificity,and AUC were 58.1%,78.3%,and 0.769,respectively.With the exception of males 31-40 and 0-10,the probability of CVFS predicting first stroke in males and females was close to the actual incidence.The sensitivity,specificity,and AUC for predicting first-episode stroke in males were 56.4%,76.4%,and 0.682,respectively.The sensitivity,specificity,and AUC

关 键 词：卒中 风险评估 脑血管功能积分 弗明汉卒中风险积分量表 

分 类 号：R743.3[医药卫生—神经病学与精神病学]