NIHSS绝对值变化与NIHSS变化率对脑梗死患者残疾预测能力的比较研究

The comparison research of the absolute change of National Institutes of Health Stroke Scale(NIHSS) scores with the percent change of NIHSS scores to predict the functional outcome of the patients with stroke

目的探讨美国国立卫生研究院卒中量表(NIHSS)绝对值的变化与NIHSS变化率对脑梗死患者功能残疾的预测价值。方法采用前瞻性设计对10个临床研究中心急性期脑梗死患者的数据进行分析,筛选出入院当天、发病90d NIHSS评分和BI数据资料完整患者953例,按入院时NIHSS评分分为轻、中、重度,以BI作为功能残疾疗效判定"金标准",应用ROC比较NIHSS绝对值变化与NIHSS变化率对患者功能残疾的判断价值。结果轻、中、重度患者AUC曲线下面积分别为0.60、0.76、0.93,与AUC曲线下面积=0.50比较,中、重度患者差异有统计学意义(P<0.05)。NIHSS变化率在轻、中、重度患者中分别为0.76、0.85、0.97,与AUC曲线下面积=0.50比较,差异均有明显统计学意义(P<0.01)。脑梗死患者良好功能结局的最佳NIHSS绝对值变化的界值在轻、中、重度患者中分别为2.5、4.5、14.5;敏感性分别为0.57、0.92、1.00,特异性分别为0.61、0.50、0.89;NIHSS变化率的界值在轻、中、重度患者中分别为70.8%、74.7%、84.9%;敏感性分别为0.63、0.82、1.00,特异性分别为0.78、0.75、0.94。结论 NIHSS绝对值变化、NIHSS变化率对患者功能残疾的预测能力随着神经功能缺损程度的增加而增大,而后者对结局预测能力更佳。

Objective To evaluate the value of the absolute and percent change of NIHSS scores to predict the functional outcome of the patients with stroke.Methods We prospectively analyzed clinical data of 953 patients derived from 10 clinical stroke research centers with NIHSS scores at admission and on 90d and BI scores were included.According to NIHSS scores,the severity of diseases was divided into three levels：mild,moderate,and severe.BI scores were used as gold standard to define the therapeutic efficiency of disability.ROC analyses were chosen to evaluate the value of the absolute and percent change of NIHSS scores to predict the outcomes.Results ROC analysis revealed that AUC value of the absolute change of NIHSS scores in three levels were 0.60,0.76 and 0.93,respectively.Compared to AUC value of 0.50,the difference between the moderate and severe levels were significant（P0.05）.In the absolute change of NIHSS scores,the best cutoff value for three levels were 2.5（sensitivity 0.57,specificity 0.61）,4.5（sensitivity 0.92,specificity 0.50） and 14.5（sensitivity 1.00,specificity 0.89）,respectively.ROC analysis revealed that AUC value of the percent change of NIHSS scores in three levels were 0.76,0.85 and 0.97,respectively.Compared to AUC value of 0.50,the difference in the three levels were significant（P0.01）.In the percent change of NIHSS scores,the best cutoff value for three levels were 70.8%（sensitivity 0.63,specificity 0.78）,74.7%（sensitivity 0.82,specificity 0.75） and 84.9%（sensitivity 1.00,specificity 0.94）,respectively.Conclusions The predictive abilities of the absolute and percent change of NIHSS scores are more powerful in severe strokes,and the latter has better predictive ability.