40Hz听性稳态反应预测大脑中动脉供血区梗死的恶性过程-回顾性病例系列研究

The 40 Hz auditory steady-state response pmlicting the malignant process of niddle cerebral mery territory infamion： a retrospective case series study

目的探讨40Hz听性稳态反应（40 Hz auditory steady—state response，40HzASSR）对大脑中动脉供血区梗死患者恶性过程的预测价值。方法收入神经重症监护病房（neuro—intensive care unite，NICU）的大脑中动脉供血区梗死患者入院后72h内行40HzASSR以及脑干听觉诱发电位（brainstem auditory evoked potential，BAEP）检查，同时行美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，N1HSS）评分。采用多变量logistic回归分析确定恶性过程的影响因素。对恶性过程相关指标进行接受者操作特征（receiver operating chamcteristic，ROC）曲线分析，明确40HzASSR对大脑中动脉供血区梗死恶性过程的预测价值。结果共纳入104例大脑中动脉供血区梗死患者，其中恶性过程组59例，非恶性过程组45例，两组基线NIHSS评分[（17．25±7．23）分对（20．40±8．09）分；t=-2．055，P=0．043）、梗死体积[（105．85±73．37）mm^3 对（179．15±144．38）耐；t=-3．011，P=0．004]、白细胞计数[（10．26±3．14）×10’／L对（13．45±5．42）×10^9／L；t=-3．336，P=0．001]、40 Hz ASSR（Z=-3．237，P=0．001）和短潜伏期体感诱发电位（Z=-3．130，P=0．002）分级存在显著差异。多变量logistic回归分析显示，40HzASSR[优势比（odds ratio，OR）3．347，95％可信区间（confidence interval，CI）1．630-6．872，P=0．014]、梗死体积（OR1．006，95％CI．1．001—1．012，P=0．003）和白细胞计数（OR 1．277，95％ci1．074-1．402，P=0．001）为大脑中动脉供血区梗死患者出现恶性过程的独立预测因素。40HzASSR为3级时预测恶性过程的敏感性为39．5％，特异性为94．4％。结论40 Hz ASSR对大脑中动脉供血区梗死患者的恶性过程具有重要的预测价值。’

Objective To investigate the predictive value of the 40 Hz auditory steady-state response （ASSR） in patients with the malignant process of middle cerebral artery territory infarction. Methods The 40 Hz ASSR and brainstem auditory evoked potential （BAEP） were performed within 72 hours after patients with middle cerebral artery territory infarction admitted in the neuro-intensive care unite （NICU）. At the same time, the National Institutes of Health Stroke Scale （NIHSS） scores wexe assessed. Multivariable logistic regression analysis was used to determine the influencing factors of the malignant process. The relevant indicators of the malignant process were analyzed by the receiver operating characteristic-（ROC） curve in order to clear the predictive value of 40 Hz ASSR in the mali[gmat process of middle cerebral artery territory infarction. ResultsA total of 104 patients with supratentorial middle cerebral artery territory infarction were included. They were divided into the malignant process group （n =59）or the non-maligmnt process group （n=45）. There were significant differences in the baseline NIHSS scores （17. 25± 7. 23 vs. 20. 40 ±8. 09; t = - 2. 055, P = 0. 043）, infarct volume （105.85 ± 73.37 mm3 vs. 179.15 ± 144.38 mm^3; t = -3.011, P = 0. 004）, leukocyte count （E 10. 26±3. 14] ×109/L vs. [ 13.45±5.42]× 10^9/L; t = -3. 336, P=O. 001）, 40 Hz ASSR （Z = -3. 237, P=0. 001）, and short-latency somatosensory evoked potentials （Z= -3. 130, P=0. 002） grade between the malignant process group and the non-malignant process group. Multivariate logistic regression analysis showed that the 40 Hz ASSR （odds ratio [ OR] 3. 347, 95% confidence interval [ CI] 1. 630 - 6. 872; P = 0. 014）, infarct volume （OR 1. 006, 95% CI 1.001 - 1.012, P = 0. 003）, and leukocyte count （OR 1.277, 95% CI 1. 074 - 1. 402; P =0. 001） were the independent predictors in patients with the malignant process of middle cerebral artery territory infarction. When the 40 Hz ASSR was grade 3, the sensitivity and specificity of predicting malignant process were 39. 5% and 94. 4%. Conclusions The 40 Hz ASSR has an important predictive value in patients with the malignant process of middle cerebral artery territory infarction.