NIHSS评分与急性脑梗死脑动脉狭窄相关性研究

Relationship between artery stenosis and National Institutes of Health Stroke Scale scoring in patients with acute cerebral infarction

目的探讨美国国立卫生院卒中量表(NIHSS)评分与脑动脉狭窄部位及程度的相关性。方法选取2003年12月至2005年8月南京军区南京总医院收治的发病48h内急性脑梗死患者66例。根据脑血管造影(DSA)结果,按狭窄程度分为狭窄组(38例)及非狭窄组(28例)。狭窄组中按狭窄部位分为颈内动脉组(18例)、主干组(8例)、分支组(7例)、椎基底动脉组(5例),结合NIHSS评分及临床资料进行回顾性分析。结果狭窄组中NIHSS评分高于非狭窄组。颈内动脉组的NIHSS评分高于分支组(P=0.004)与椎基底动脉组(P<0.01),而与主干组相比差异无统计学意义。分支组NIHSS评分高于椎基底动脉组(P=0.02)。ROC曲线分析可将NIHSS=8分作为区分是否伴有脑动脉狭窄的诊断决策点。结论NIHSS评分与急性脑梗死患者脑动脉狭窄程度及血管分布有关。NIHSS≥8分对于急性脑梗死患者是否伴有脑动脉狭窄有一定的预测性。

Objective To approach the relationships between National Institutes of Health Stroke Scale（NIHSS） scoring and cerebral artery stenosis. Methods A total of 66 patients with acute cerebral infarction underwent DSA within 48hr of stroke onset. Baseline NIHSS score was assessed before DSA. According to the stenosis presence,patients were divided into stenosis group（ n = 38 ）and non-stenosis group（ n = 28 ）. In stenosis group, patients were divided into four groups according to site of arterial stellosis： （ 1 ）the internal carotid artery（ICA group,n = 18） ; （2） stem of the middle cerebral artery or the anterior cerebral artery（ Stem group ; n = 8 ） ; （ 3 ） branches of middle cerebral artery or the anterior cerebral artery （ Branch group ; n = 7 ） ; （4） vertebral basilar artery （ VA-BA group ; n = 5 ）. Results The mean NIHSS score was higher in the stenosis group than in the non-stenosis group. NIHSS score was higher in the ICA group than in the Branch group （P =0. 004） or VA-BA group（P 〈0. 01 ）but was not higher than the Stem group. NIHSS score was higher in the Branch group than in the VA-BA group（ P = 0. 02）. ROC curve analysis suggested that NIHSS score of 8 represented a good cutoff point for discriminating patients with arterial stenosis from those without. Conclusion NIHSS score is related to the site and the degree of cerebral artery stenosis in patients with acute cerebral infarction. NIHSS score≥8 can be an indication for cerebral artery stenosis.