慢性意识障碍患者结局预测模型的系统综述

doi:10.3969/j.issn.1006-9771.2022.02.009

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (2): 190-198.doi: 10.3969/j.issn.1006-9771.2022.02.009

慢性意识障碍患者结局预测模型的系统综述

俞快¹,张利²,叶祥明²()

1.浙江中医药大学第二临床医学院,浙江杭州市 310053
2.浙江省人民医院,浙江杭州市 310004

收稿日期:2021-10-09 修回日期:2022-01-18 出版日期:2022-02-25 发布日期:2022-03-09
通讯作者: 叶祥明 E-mail:yexmdr@126.com
作者简介:俞快(1995-),女,汉族,浙江杭州市人,硕士研究生,主要研究方向：神经康复。
基金资助:
1.浙江省自然科学基金项目(LGF20H170011);1.浙江省自然科学基金项目(LGF22H170006);2.浙江省医药卫生科技项目(2019KY296);3.浙江省中医药科技计划项目(2020ZB011)

Prediction models of outcome for patients with prolonged disorders of consciousness: a systematic review

YU Kuai¹,ZHANG Li²,YE Xiangming²()

1. Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
2. Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310004, China

Received:2021-10-09 Revised:2022-01-18 Published:2022-02-25 Online:2022-03-09
Contact: YE Xiangming E-mail:yexmdr@126.com
Supported by:
Natural Science Foundation of Zhejiang Province(LGF20H170011);Natural Science Foundation of Zhejiang Province(LGF22H170006);Zhejiang Medical and Health Technology Project(2019KY296);Science and Technology Program of Chinese Medicine of Zhejiang Province(2020ZB011)

摘要/Abstract

摘要：

目的系统评价慢性意识障碍患者结局预测模型的组成因子和准确率。方法采用主题词检索方式,检索PubMed、Web of Science、中国知网、万方数据建库至2021年9月30日慢性意识障碍患者结局预测模型的相关文献,提取内容为作者、出版年份、研究对象、监测项目、主要结局指标和结论。结果共返回文献4 313篇,最终纳入37篇,文献类型包括随机对照试验、队列研究,发表时间主要集中在2012年至2021年,研究对象为慢性意识障碍患者,预测模型的组成因子包括临床量表、神经影像学检查、神经电生理学检查和实验室指标。结论预测模型对慢性意识障碍患者的远期结局有一定的参考价值。目前的预测模型大多数只由有限的一项或几项技术手段构成,准确率参差不齐,其中昏迷恢复量表修订版、默认网络、联合多种诱发电位的脑电图分析相关的预测模型具有较高准确率,但尚未建立统一的适配标准。

关键词: 意识障碍, 结局, 预测模型, 系统综述

Abstract:

Objective To systematicly evaluate the constituent factors and accuracy of prediction models of outcome for patients with prolonged disorders of consciousness. Methods Articles about prediction models of outcome for patients with prolonged disorders of consciousness were retrieved from PubMed, Web of Science, CNKI and Wanfang Data until September 30th, 2021. The authors, publishing times, subjects, predictive indicators, outcomes and conclusions were extracted. Results A total of 4 313 articles were returned and 37 included, comprising randomized controlled trials and cohort studies, which published mainly from 2012 to 2021. The subjects were patients with prolonged disorders of consciousness, and their predictions consisted of clinical assessment scales, neuroimaging, neuroelectrophysiology and laboratory indicators. Conclusion Prediction models may be valuable for the long-term outcomes of patients with prolonged disorders of consciousness. Most of the current prediction models are composed of only a limited number of technical means, and the accuracy is uneven. Coma Recovery Scale-revised, default mode network and multiple evoked potentials-related prediction models are accurate, but lack a unified adaptation standard.

Key words: disorders of consciousness, outcome, prediction model, systematic review

中图分类号:

R741

俞快,张利,叶祥明. 慢性意识障碍患者结局预测模型的系统综述[J]. 《中国康复理论与实践》, 2022, 28(2): 190-198.

YU Kuai,ZHANG Li,YE Xiangming. Prediction models of outcome for patients with prolonged disorders of consciousness: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 190-198.

图/表 2

图1

表1

纳入文献的一般情况"

纳入文献	研究对象	监测项目	主要结局指标	结论
唐秋月等^[1](2020)	脑卒中、GCS < 8	GCS、FOUR、mRS	mRS 5~6分,预后不良;mRS 0~4分,预后良好	FOUR对预后的评估能力优于GCS
Estraneo等^[2](2013)	pDoC	CRS-R	意识恢复情况	CRS-R是意识恢复的显著独立预测因素
Bodien等^[3](2016)	意识障碍	CRS-R	觉醒程度	CRS-R可识别MCS与EMCS
Sattin等^[4](2015)	成年人,意识障碍	CRS-R	觉醒程度	CRS-R修正评分可提示患者预后
Pincherle等^[5](2019)	16岁以上,pDoC	CRS-R、MBT-r	GOS	MBT-r可作为CRS-R的补充使预后预测更精准
Aubinet等^[6](2021)	18岁以上,pDoC	CRS-R、SECONDs	意识状态	SECONDs简便有效
Thibaut等^[7](2012)	意识障碍	fMRI	意识状态	皮质网络代谢与CRS-R正相关
Sitt等^[8](2014)	意识障碍	fMRI	意识状态	DMN连接强度与意识水平显著相关
Silva等^[9](2015)	GCS < 8	fMRI	CRS-R	脑功能连接与患者未来的神经恢复之间存在显著关联性
Di Perri等^[10](2016)	意识障碍	fMRI	意识状态	默认网络和执行控制网络之间的负功能连接可预测预后
Stender等^[11](2015)	意识障碍	fMRI	CRS-R	皮质代谢率和意识水平恢复之间存在显著相关性
Yu等^[12](2021)	意识障碍	fMRI	GOS-E	FC是最准确的单因子预测模型,因子预测模型优于单因子
Song等^[13](2018)	意识障碍	fMRI	CRS-R、GOS	多领域预后模型准确高
Wang等^[14](2015)	VS/UWS	fMRI	CRS-R	听觉皮质的激活类型和激活量与预后显著相关
Okumura等^[15](2014)	意识障碍	fMRI	意识状态	颞上回激活可能预示意识状态改善
Monti等^[16](2013)	意识障碍	EEG	意识状态	视觉认知与预后有所关联
Babiloni等^[17](2009)	意识障碍	EEG	认知功能水平量表	α振荡可能为意识恢复的预测因素
Hofmeijer等^[18](2015)	意识障碍	EEG	EEG特征	弥散性慢波提示预后良好;等电位、低电压或爆发波的爆发性抑制提示预后不良
Schnakers等^[19](2008)	缺氧缺血性脑病后意识障碍	EEG	意识状态	脑电双频指数与GCS和CRS-R评分显著正相关
Holeckova等^[20](2006)	意识障碍	EEG	意识状态	唤名刺激能预测结局
Pan等^[21](2014)	意识障碍	EEG	脑机接口设备是否检出命令跟随	视觉刺激可以检测意识障碍患者残存的意识
Venturella等^[22](2019)	意识障碍	EEG	意识状态	痛觉是意识障碍患者预后分析良好的预测因子
Chéliout-Heraut等^[23](2001)	意识障碍	EEG	意识状态	睡眠纺锤波是有利预后预测因子
Wislowska等^[24](2017)	儿童,GCS < 5	EEG	CRS-R	睡眠纺锤波密度与CRS-R评分呈线性正相关
Zheng等^[25](2013)	意识障碍	EEG	意识状态	早期体感诱发电位缺失的患者均预后不良
Cavinato等^[26](2009)	弥漫性轴索损伤、意识障碍	EEG	意识是否恢复	P300是VS患者意识恢复的一个强有力的预测因子
Luaute等^[27](2010)	VS	EEG	GOS	中潜伏期听觉诱发电位皮质成分缺失与意识恶化有关
翁绮贞等^[28](2021)	GCS < 8	脑干听觉诱发电位、EEG	是否觉醒	脑干听觉诱发电位联合EEG评估预后准确性高
方红^[29](2015)	GCS < 8	脑干听觉诱发电位、体感诱发电位	死亡、VS：预后不良;恢复良好、轻或重的残疾：预后良好	脑干听觉诱发电位、体感诱发电位有助于预后预测
Kotchoubey等^[30](2005)	VS、MCS	EEG	意识状态	失匹配负波可有效预测预后
Steppacher等^[31](2020)	PVS、MCS	EEG	意识是否恢复	N400与P300联合应用有良好的预后预测能力
Casarotto等^[32](2016)	意识障碍	TMS-EEG	意识状态是否改善	PCI_max > 0.31预示良好结局
Kellermann等^[33](2016)	MCS、VS	S100B	GOS	血清中S100B > 0.7 ng/mL必然造成死亡的临床结局
Lei等^[34](2015)	意识障碍	GFAP	GOS	血清GFAP升高是不良结局的预测因子
Czeiter等^[35](2012)	意识障碍	GFAP	是否存活	GFAP血清值与致死率显著正相关
Mondello等^[36](2016)	意识障碍	GFAP、UCH-L1、S100B	GOS	GFAP和UCH-L1可预测不良结局
Žurek等^[37](2012)	意识障碍	Tau蛋白	GOS	Tau蛋白与预后相关性尚不明确

表1

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慢性意识障碍患者结局预测模型的系统综述

Prediction models of outcome for patients with prolonged disorders of consciousness: a systematic review

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