超敏C反应蛋白、同型半胱氨酸和Essen评分法及联合应用在预测腔隙性脑梗死预后中的价值

High-sensitivity c-reactive protein,Homocysteine and Essen scoring and combined value in predicting the prognosis of cerebral lacunar infarction

目的评价高超敏C反应蛋白、同型半胱氨酸和Essen评分法及联合应用对腔隙性脑梗死患者预后风险评估的临床价值。方法对125例腔隙性脑梗塞患者进行1年随访观察,通过应用受试者工作特征(ROC)曲线,计算ROC曲线下面积比较四种预测腔隙性脑梗死预后评分法的价值。结果 (1)125例患者中共失访7例,失访率5.6%。其余118例在随访1年中有17例因出现新的梗死病灶和(或)不良心脏事件而入院治疗;(2)Essen+CRP评分法、Essen评分法、CRP评分法和Essen+Hcy评分法的ROC曲线下面积(95%CI)分别为0.755(0.619～0.891)、0.730(0.595～0.865)、0.695(0.556～0.834)和0.725(0.587～0.863),Es-sen+CRP评分法优于其他三种评分法;(3)Essen+CRP评分法低危组(n=35)、高危组(n=67)和极高危组(n=16)心脑血管事件发生率分别为8.57%、11.94%和37.50%,3组比较差异明显(χ2=8.217,P<0.05)。结论 4种方法在评估腔隙性脑梗死预后方面均有一定的临床价值,但Essen+CRP评分法能更好地鉴别高危患者。

Objective To evaluate the clinic value of hs-CRP,homocystine level and Essen scoring and combined value in predicting the prognosis of cerebral lacunar infarction.Methods 125 cases of lacunar cerebral infarction patients were followed-up for one year.By application of receiver-operating characteristic（ROC） curve and calculation of the area under the ROC curves,four types of lacunar cerebral infarction prognostic score were compared.Results（1） 7 of 125 patients were lost to follow-up,and lost to follow-up rate was 5.6%.The other 118 cases were followed up for one year and among them 17 cases of new infarction lesions and（or） aderse cardiac events were admitted to hospital for treatment.（2） The area under the ROC curves（95% CI） for Essen＋CRP evaluation method,Essen evaluation method,CRP pointrating method and Essen＋Hcy evaluation method was 0.755（0.619～0.891）,and 0.730（0.595～0.865）,and 0.695（0.556～0.834） and 0.725（0.587～0.863）,respectivedly.Essen ＋ CRP evaluation method was better than the other three evaluation method.（3） In low-risk group（n=35）,high-risk group（n=67） and very high risk group by Essen＋CRP grading（n=16） cerebrovascular event rate was 8.57%,11.94% and 37.50%,respectively.The difference between the three groups was statistically significant（χ2=8.217,P0.05）.Conclusions Four methods in evaluating the prognosis of lacunar cerebral infarction have certain clinical value,but Essen ＋ CRP evaluation method is better in identifying high-risk patients.