椎-基底动脉系统急性缺血性卒中溶栓干预预测量表的编制及其应用价值研究

Thrombolysis predictive scale for acute ischemic stroke of vertebrobasilar artery (TPS-VBA)

目的本研究旨在于编制椎-基底动脉系统急性缺血性脑血管病溶栓干预风险-效益评价量表,以期预测溶栓干预的风险和收益,从而达到指导临床溶栓决策和提高溶栓疗效的目的。方法本研究以2003年2月-2008年12月间宣武医院卒中中心收治的98例椎-基底动脉系统急性缺血性脑血管病溶栓患者为研究对象,采用评分者信度、准则关联效度,以及受试者工作特征曲线(ROC)等方法对量表的信度、效度、临床预测价值进行检测分析。结果信度检测结果提示,量表的总评分和分项评分均显示较高的α信度系数。以患者溶栓干预后30天mRS评分改善≤2作为溶栓干预有效性的评价准则,对不同溶栓干预预后患者的基线风险-效益量表评分进行显著性检测分析提示,溶栓后改善组、无改善组、恶化组之间有十分显著的统计学差异(P<0.01)。POSThoc分析提示,以35分和45分分别作为溶栓干预"良好预后"和"不良预后"预测界点显示较好的预测效果,ROC曲线下面积分别为0.824和0.873。结论在本研究的平台上,椎-基底动脉系统急性缺血性脑血管病溶栓干预的风险-效益评价量表显示较好的信度、效度、临床应用价值和经济学价值,有望成为一种新的用于预测溶栓治疗风险和收益,指导临床溶栓干预决策的简便、有效评价工具。

Objective The purpose of the study is to derivate and validate a new scale for posterior circulation thrombolysis outcomes predicting. Methods Based on the previous work, we predefined ten variables as indicators to develop a thrombolysis predictive scale for acute ischemic stroke of vertebrobasilar artery （TPS-VBA）. Ninety-eight patients were enrolled to validate TPS-VBA by inter-rater reliability, criteria-related validity and clinical predictive value. Results Inter-rater reliability test indicated that intraclass correlation coefficient for total score of TPS-VBA was high. In criteria-related validity test, baseline TPS-VBA scores were showed to be statistically different among subgroups with different thrombolysis outcomes （P0.001）. Trend test indicated that baseline TPS-VBA score was highly predictive of thrombolysis outcomes （P0.001）. By post hoc analysis, 35 and 45 were verified as preferable threshold scores for good and catastrophic outcomes predicting, and the area under receiver operating characteristic curve were 0.873 and 0.842, respectively. Conclusion TPS-VBA is a reliable and effective tool for posterior circulation thrombolysis decision-making. However, TPS-VBA needs further validation in large stroke samples in multi-center clinical observation.