ESRS评分对前循环急性缺血性脑卒中患者脑血管狭窄的预测作用

Predictive value of Essen stroke risk scale scores in stenosis of patients with anterior circulation acute ischemic stroke

目的探讨Essen卒中风险评估量表（ESRS）评分对动脉粥样硬化性前循环急性缺血性脑卒中患者脑血管狭窄的预测价值。方法选择扬州大学附属扬州市江都人民医院神经内科自2011年6月至2013年6月收治的接受头颅＋颈部CT血管造影检查的动脉粥样硬化性前循环急性缺血性脑卒中患者98例进行ESRS评分，根据ESRS评分分为低危组35例、高危组44例、极高危组19例，分析ESRS评分与患者脑血管形态学特点的关系及其对脑血管狭窄的预测价值。结果（1）3组患者间脑血管狭窄病变部位（单纯颅内段、单纯颅外段、颅内颅外段同时）分布差异无统计学意义（P〉0．05）。（2）在症状侧和非症状侧大血管中，ESRS评分与脑血管狭窄程度之间均不仅存在相关关系且均为线性关系（x^2=9．784，P=0．002；X2=9．215，P=0．002）。（3）当ESRS评分≥3分时，预测脑血管轻度狭窄的敏感性为63．6％，特异性为53．4％，受试者工作特征曲线（ROC）曲线下面积为0．595（P=0．182，95％CI：0．445～0．764）；预测脑血管中度、重度狭窄及闭塞的敏感性为60．3％，特异性为66．7％，ROC曲线下面积为0．679（P=0．005，95％CI：0．553～0．805）。结论对动脉粥样硬化性前循环急性缺血性脑卒中患者应用ESRS评分能够在一定程度上反映患者脑血管的狭窄程度。ESRS评分≥3分的高危人群应重视脑血管检查，以为及早、有效的分层干预提供一定参考依据。

Objective To investigate the predictive value of Essen stroke risk scale （ESRS） scores in stenosis of patients with anterior circulation acute ischemic stroke. Methods A total of 98 patients with atherosclerotic stroke in anterior circulation, admitted to our hospital from June 2011 to June 2013, were selected and performed head＋neck CTA inspection cycle and ESRS. According to the ESRS scores, the patients were divided into low risk group （n=35）, high risk group （n=44） and extremely high risk group （n=19）. The relationship between the cerebrovascular morphology characteristics and ESRS scores were analyzed, and the predictive value of ESRS scores in stenosis was analyzed. Results （1） The distributions of these stenosis （the intracranial segment, the extracranial segment and combined intracranial and extracranial segments） were not significantly different among the three groups （P〉0.05）. （2） Following the increase of ESRS scores, the degrees of luminal stenosis showed an increased trend in both circulation symptom side and non-symptom side （x^2=9.784, P=0.002; x^2=9.215, P=0.002）. （3） When the ESRS scores were higher than or equal to 3 points, the sensitivity of predicting mild stenosis was 63.6%, specificity 53.4%, with area under receiver operating characteristic curve （AUC） of 0.595 （P= 0.182, 95%CI： 0.445-0.764）; the sensitivity of predicting moderate stenosis, severe stenosis and occlusion was 60.3%, specificity 66.7%, with AUC of 0.679 （P=0.005, 95%CI： 0.553-0.805）. Conclusions ESRS scores can predict the severity of the stenosis in patients with atherosclerotic cerebral stroke ofanterior circulation. The patients having ESRS ≥ 3 scores should accept cerebrovascular examination to provide a certain basis for early and effective stratified intervention.