不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较

doi:10.3969/j.issn.1006-9771.2021.03.002

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (3): 256-260.doi: 10.3969/j.issn.1006-9771.2021.03.002

不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较

王娜^1,²(),李培兰^1,²,刘芦姗^1,²,王丰容^1,²

^1.首都医科大学康复医学院，北京市 100068
^2.中国康复研究中心北京博爱医院急诊科，北京市 100068

收稿日期:2020-08-21 修回日期:2020-10-27 出版日期:2021-03-25 发布日期:2021-04-02
通讯作者: 王娜 E-mail:wangnaxxyy@163.com
作者简介:王娜(1977-)，女，汉族，河北安国市人，博士，副主任医师，主要研究方向：急危重症、急性脑血管病。
基金资助:
中国残疾人联合会课题(20&YB019)

Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems

Na WANG^1,²(),Pei-lan LI^1,²,Lu-shan LIU^1,²,Feng-rong WANG^1,²

^1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
^2.Emergency Department, Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China

Received:2020-08-21 Revised:2020-10-27 Published:2021-03-25 Online:2021-04-02
Contact: Na WANG E-mail:wangnaxxyy@163.com
Supported by:
China Disabled Persons' Federation Research Projects(20&YB019)

摘要/Abstract

摘要： 目的

比较缺血性卒中风险预测评分(iScore)，住院前并发症、意识水平、年龄和局灶性神经功能缺损评分(PLAN)，洛桑急性缺血性脑卒中登记评分(ASTRAL)和血管事件患者总体健康风险评分(THRIVE)对急性缺血性脑卒中(AIS)患者30 d、3个月和1年死亡风险的预测能力。

方法

2015年8月~2018年6月，连续纳入本院急诊病房AIS患者323例，以入组时间为起点，分别于30 d、3个月、1年后随访，应用受试者工作特征曲线(ROC)评价iScore、PLAN、ASTRAL和THRIVE对死亡风险的预测作用。

结果

AIS患者30 d、3个月、1年的全因死亡率分别为12.4% (40/323)、17.3% (56/323)和25.7% (83/323)。4种评分系统曲线下面积(AUC)从大到小依次为iScore、PLAN、ASTRAL和THRIVE，其中iScore与THRIVE之间有显著性差异(Z > 1.990, P < 0.05)，其他评分系统间无显著性差异(Z < 1.943, P > 0.05)。

结论

iScore、PLAN、ASTRAL和THRIVE均能有效预测急诊病房AIS患者短期和长期死亡风险，以iScore最优。但iScore计算程序相对复杂，PLAN和ASTRAL更适用于急诊科应用。

关键词: 急性缺血性脑卒中, 死亡, 预后

Abstract: Objective

To compare the prediction of Ischemic Stroke Predictive Risk Score (iScore), Preadmission Comorbidities, Level of Consciousness, Age, and Neurologic Deficit (PLAN), Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and Totaled Health Risks in Vascular Events (THRIVE) for short- and long-term death for patients with acute ischemic stroke (AIS).

Methods

From August, 2015 to June, 2018, 323 AIS patients in emergency ward were included, and followed up 30 days, three months and a year after including. Receiver operating characteristic (ROC) curve was used to analyze the predictive effects of iScore, PLAN, ASTRAL and THRIVE.

Results

The all-cause mortality 30 days, three months and a year after including was 12.4% (40/323), 17.3% (56/323) and 25.7% (83/323), respectively. The area under curve (AUC) from more to less arranged as iScore, PLAN, ASTRAL and THRIVES. There was significant difference of AUC between iScore and THRIVE (Z > 1.990, P < 0.05), but not among the others (Z < 1.943, P > 0.05).

Conclusion

iScore, PLAN, ASTRAL and THRIVE may predict short- and long-term death of AIS patients in the emergency well, and iScore is the best. However, the procedure of iScore is complex, it is recommended to use PLAN and ASTRAL for emergency.

Key words: acute ischemic stroke, death, pronosis

中图分类号:

R743.3

王娜,李培兰,刘芦姗,王丰容. 不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较[J]. 《中国康复理论与实践》, 2021, 27(3): 256-260.

Na WANG,Pei-lan LI,Lu-shan LIU,Feng-rong WANG. Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 256-260.

图/表 3

表1

表2

表3

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项目	统计值
性别(n)
男	170
女	153
年龄(岁)	76(63, 83)
住院时间(d)	12(6, 14)
房颤(n)	67
高血压(n)	251
糖尿病(n)	124
冠心病(n)	106
脑卒中史(n)	153
临床类型(n)
腔隙性梗死	166
部分前循环梗死	53
完全前循环梗死	54
后循环梗死	50
GCS	12(10, 15)
NIHSS	7(2, 13)
iScore (30 d)	125(96, 176)
iScore (1年)	127(98, 177)
PLAN	12.0(9.5, 15.0)
ASTRAL	23.2(18.4, 32.0)
THRIVE	4(3, 5)
30 d死亡(n)	40
3个月死亡(n)	56
1年死亡(n)	83

时间	评分系统	AUC (95%CI)	切点(分)	约登指数	敏感性	特异性	H-L检验(P值)
30 d	iScore (30 d)	0.892(0.852~0.923)	164	0.6736	0.80	0.87	6.553(0.586)
	PLAN	0.891(0.852~0.923)	14.8	0.6948	0.82	0.88	8.029(0.431)
	ASTRAL	0.882(0.842~0.915)	27.4	0.6314	0.73	0.90	4.763(0.783)
	THRIVE	0.841(0.797~0.880)	4	0.6442	0.69	0.90	7.079(0.132)
3个月	iScore (30 d)	0.877(0.836~0.910)	164	0.6491	0.83	0.82	8.231(0.413)
	PLAN	0.871(0.830~0.906)	14.2	0.6154	0.79	0.82	6.575(0.563)
	ASTRAL	0.870(0.829~0.905)	27.4	0.6235	0.76	0.84	4.765(0.782)
	THRIVE	0.821(0.775~0.865)	4	0.5800	0.72	0.86	8.946(0.062)
1年	iScore (1年)	0.876(0.835~0.910)	164	0.6257	0.87	0.76	10.946(0.205)
	PLAN	0.875(0.834~0.909)	12.7	0.6411	0.74	0.90	6.343(0.609)
	ASTRAL	0.870(0.829~0.905)	27.4	0.5873	0.80	0.78	7.837(0.450)
	THRIVE	0.828(0.783~0.868)	4	0.5618	0.77	0.80	6.717(0.152)

时间	评分系统	差异	Z值	P值
30 d	iScore vs. PLAN	0.000	0.015	0.988
	iScore vs. ASTRAL	0.009	0.692	0.489
	iScore vs. THRIVE	0.050	1.990	0.047
	PLAN vs. ASTRAL	0.009	0.027	0.743
	PLAN vs. THRIVE	0.050	1.789	0.074
	ASTRAL vs. THRIVE	0.041	1.497	0.134
3个月	iScore vs. PLAN	0.005	0.211	0.833
	iScore vs. ASTRAL	0.006	0.489	0.635
	iScore vs. THRIVE	0.055	2.195	0.028
	PLAN vs. ASTRAL	0.001	0.049	0.961
	PLAN vs. THRIVE	0.050	1.805	0.071
	ASTRAL vs. THRIVE	0.005	1.845	0.065
1年	iScore vs. PLAN	0.001	0.053	0.958
	iScore vs. ASTRAL	0.006	0.549	0.583
	iScore vs. THRIVE	0.048	2.209	0.022
	PLAN vs. ASTRAL	0.005	0.244	0.807
	PLAN vs. THRIVE	0.047	1.912	0.056
	ASTRAL vs. THRIVE	0.042	1.943	0.052

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不同评分系统预测急性缺血性脑卒中患者的短期和长期死亡风险比较

Prediction of Short- and Long-term Death in Patients with Acute Ischemic Stroke Using Various Scoring Systems

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