《中国康复理论与实践》

《中国康复理论与实践》 ›› 2010, Vol. 16 ›› Issue (2): 109-112.

• 论文 • 上一篇    下一篇

NIHSS评分结合CT血管成像对超早期急性缺血性脑卒中临床预后的预测价值

黄小钦，贾建平，马青峰，马欣，楚长彪   

  1. 首都医科大学宣武医院神经内科，北京市 100053。
  • 收稿日期:2010-01-15 修回日期:1900-01-01 出版日期:2010-02-25 发布日期:2010-02-25

NIHSS with CT Angiography for Clinical Prognosis of Acute Ischemic Stroke at Ultra-early Stage

HUANG Xiao-qin, JIA Jian-ping, MA Qing-feng, et al.   

  1. Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
  • Received:2010-01-15 Revised:1900-01-01 Published:2010-02-25 Online:2010-02-25

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被引次数

39

摘要： 目的探讨美国国立卫生研究院卒中量表(NIHSS)评分结合超早期CT血管成像(CTA)对判断急性超早期缺血性脑卒中临床预后的作用。方法对发病≤6 h的70例急性缺血性脑卒中患者进行头颅CTA检查，并在入院、出院时进行NIHSS评分。结果70例患者中32例CTA检查显示血管正常，血管闭塞38例。NIHSS＞8分组临床预后较差(P<0.01)。血管闭塞组患者出院时NIHSS评分高于无血管闭塞组(P<0.01)，无血管闭塞组有25例(78.1%)预后良好，血管闭塞组预后良好17例(44.7%)，两组间有显著性差异(P<0.05)。血管闭塞组溶栓治疗患者预后良好比率(58.8%)高于未溶栓治疗患者比率(31.82%，P<0.05)。经Logistic回归分析，入院时NIHSS评分及CTA显示的血管闭塞与否与早期临床预后相关(分别为r=0.25，P<0.05；r=0.73，P<0.001)，入院NIHSS评分(OR=0.09, 95%CI=0.07～0.12, P<0.01)和血管是否闭塞(OR=0.12, 95%CI=0.01～0.24, P<0.05)是急性缺血性脑卒中预后的独立预测因素。以NIHSS=8为分界点预测临床预后的敏感性56.65%，特异性85.29%，阳性预测值80.00%。CTA预测临床预后的敏感性为63.89%，特异性73.53%，阳性预测值71.88%；两者结合对预后预测的敏感性70.11%，特异性91.18%，阳性预测值88.00%。结论CTA显示血管闭塞的急性缺血性脑卒中患者预后较差，CTA结合NIHSS评分有助于提高对急性缺血性脑卒中临床预后的判断及指导治疗。

关键词: 急性缺血性卒中, CT血管成像, 美国国立卫生研究院卒中量表(NIHSS), 血管闭塞, 预后

Abstract: ObjectiveTo evaluate the value of National Institute of Health Stroke Scale (NIHSS) combined with CT angiography(CTA) to predict the clinical outcome of acute ischemic stroke patients at ultra-early stage.Methods70 patients with acute ischemic stroke underwent brain CTA within 6 hours from symptom onset and were divided into two groups according to NNIHSS score, and clinical outcome was compared between two groups.ResultsThere were 38 patients with arterial occlusion on CTA and 32 patients with normal CTA. The percentage of occlusion on CTA for patients presenting with more severe neurological deficits was higher than those patients with slight to moderate deficits. The patients with occlusion on CTA and presenting with more severe deficits had a poor clinical outcome (P<0.01). 78% of patients with normal angiograms had good outcome, only 44.7% patients with arterial occlusion had a good clinical outcome(P<0.05). Both CTA evidence of vessel occlusion and admission NIHSS score correlated with clinical outcome measured by discharge NIHSS score(r=0.25, P=0.04 and r=0.73, P=0.000 respectively). The sensitivity and specificity for predicting clinical outcome by using the NIHSS score alone was 56.65% and 85.29%, and positive predictive value (PPV+) was 80.00%. There was a sensitivity of 63.89%, a specificity of 73.53%, a PPV+ of 71.88% if CTA showed vessel obstruction. If NIHSS scores combined with CTA to predict clinical outcome, the result showed a sensitivity of 70.11%, a specificity of 91.18%, a PPV+ of 88.00%.ConclusionThose patients with vessel occlusion on CTA appear to have a worse clinical outcome. NIHSS combining with CTA may increase specificity for judging prognosis and guide treatment.

Key words: acute ischemic stroke, CT angiography, National Institute of Health Stroke Scale(NIHSS), arterial occlusion, outcome