阿司匹林联合氯吡格雷治疗急性脑梗死预后预测量表的建立及其效果的初步评价

Establishment of prognosis prediction scale for aspirin combined with clopidogrel in acute cerebral infarction and preliminary evaluation of its prediction effectiveness

目的建立阿司匹林联合氯吡格雷治疗急性脑梗死预后预测量表并初步评价其效果。方法回顾性收集甘肃省人民医院神经外科自2017年10月至2019年4月收治的202例接受阿司匹林联合氯吡格雷治疗的急性脑梗死患者的临床资料,以治疗前后美国国立卫生研究院卒中量表(NIHSS)评分的差值为标准评价发病后14 d预后并将患者分为预后良好组和预后不良组,采用单因素分析及多因素Logistic回归分析筛选出影响急性脑梗死预后不良的独立危险因素并分别赋值以建立预测量表,最后将建立的预测量表应用于本组患者进行验证。结果202例患者中预后良好167例,预后不良35例。多因素Logistic回归分析显示年龄≥50岁、高血压病史、高同型半胱氨酸血症、颈动脉狭窄为影响发病后14 d预后不良的独立危险因素(P<0.05),其中年龄≥50岁赋值1分,高血压Ⅰ级赋值1分,高血压Ⅱ级赋值2分,高血压Ⅲ级赋值3分,高同型半胱氨酸血症赋值1分,颈动脉狭窄赋值1分,预测量表总分0~6分。验证结果显示,预测量表评分≥3分患者的预后不良率为91.3%(157/172),预测量表评分<3分患者的预后不良率为33.3%(10/30)。结论可以利用本研究建立的预测量表快速、精准地识别适合阿司匹林联合氯吡格雷治疗的急性脑梗死患者。

Objective To establish a prognosis prediction scale for aspirin combined with clopidogrel in treatment of acute cerebral infarction(ACI)and evaluate its prediction effectiveness.Methods A retrospective analysis of clinical features of 202 ACI patients,admitted to and accepted aspirin combined with clopidogrel in our hospital from October 2017 to April 2019,was performed.According to the differences of National Institutes of Health Stroke Scale(NIHSS)scores before and after treatment,the patients were divided into good prognosis group and poor prognosis group;univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for prognoses of acute cerebral infarction;assignment of these factors was performed,respectively,to establish prediction scale;and finally the prediction scale was applied to the patients for verification.Results Of the 202 patients,167 had a good prognosis and 35 had a poor prognosis.Multivariate Logistic regression analysis revealed that age≥50 years,hypertension,homocysteine,and carotid stenosis≥50%were independent risk factors for prognoses 14 d after onset in patients with ACI(P<0.05);the assigned values of age≥50 years,hypertension grading I,hypertension grading II,hypertension grading III,homocysteine,and carotid stenosis≥50%were 1,1,2,3,1,and 1,respectively;the total pridiction scale scores were 0-6.Validation results showed that the poor prognosis rate of patients with predictive scale scores≥3 was 91.3%(157/172)and that of patients with predictive scale scores<3 was 33.3%(10/30).Conclusion The predictive scale established in this study can be used to quickly and accurately identify patients with acute cerebral infarction who are suitable for aspirin combined with clopidogrel.