美国国立卫生院卒中量表(NIHSS)中文版多中心测评研究--附537例缺血中风多中心多时点临床测评研究

Study on multi-center investigation of the Chinese version of National Institutes of Health Stroke Scale

目的依托国家十五攻关课题,采用美国国立卫生院卒中量表（the National Institutes of Health Stroke Scale,NIHSS）中文版,对我国脑卒中人群进行信度、效度和敏感度的多中心、大样本研究。方法信度检验用Cronbach＇sα系数、Guttman Split-half和spearson相关系数（重测信度）来评价。采用人为推理判断方法评价内容效度;采用因子分析法考核量表的结构效度;通过相关分析考察量表的效标效度。各领域敏感度通过配对t检验来评估。结果完成随访评定537例。NIH-SS中文版除0 d和7 d外,有较好的条目内部一致性,各领域的重测信度除共济运动、凝视外,其他维度的重测信度系数均在0.5-1之间。各时点的累计贡献率范围为88.6%-90.17%,具有很好的结构效度;哥拉斯格结局量表（Glasgow Outcome Scale,GOS）,Barthel生活能力指数（Barthel In-dex,BI）为效标,NIHSS与二者相关性高。12个领域显示了理想的敏感度。除7 d的凝视、忽视外,NIHSS总分及各条目在各个时点有较好敏感度。结论NIHSS中译本是一个有很好信度、效度和敏感度的卒中量表,中医药研究治疗急性缺血中风适合使用急性前循环卒中的疗效评价。

Objective To investigate the reliability,validity and responsiveness of Chinese version of National Institutes of Health Stroke Scale（NIHSS）in big sample patients of multi-center with stroke in China.Methods The reliability was evaluated in 537 inpatients by using Cronbach＇s α coefficient,Guttman Split-half and Spearson correlation coefficient.The content validity of NIHSS was studied with the method of subjective reasoning and judging.The construct validity was assessed with factor analysis.Criterion validity of individual domains was assessed by comparing the linear association of the domain score with the score of these scales.Domain responsiveness was assessed with Paired Ttest.Results All scales of 14 d and 21 d showed better internal consistent.Most domains except gaze and ataxia domain demonstrated excellent reliability in test retest（Spearson correlation coefficient ranged 0.5-1）.All 12 domains demonstrated excellent constract validity（accumulative dedication rate ranged from 88.6 to 90.17%）. NIHSS total score and every item of the most domains in different time points except gaze domain of 7d were responsive.NIHSS showed high correlation with Glasgow Outcome Scale（GOS）and Barthel Index（BI）.Conclusion The Chinese version of NIHSS is a reliable,valid and responsive scale and is suitable for assessing the therapeutic effect of Chinese medicine on stroke at acute phase.