改良Essen评分对脑卒中复发的预测价值

The predictive value of a modified Essen stroke risk score for predicting recurrent stroke

目的 Essen卒中风险评分(ESRS)对卒中复发高风险患者辨别能力差。目的为将ESRS评分改良成新的卒中风险评分(SRS)以提高ESRS评分区别能力,并在缺血性卒中患者中验证。方法 SRS评分由ESRS评分增加心房颤动、高血糖、入院时血压≥140/90mmHg、颈动脉成像、C-反应蛋白(CRP)、纤维蛋白原(FIB)、同型半胱氨酸(Hcy)和低密度脂蛋白胆固醇(LDL-C)变量改良而成。C-统计值(C-statistics)代表各评分预测价值。Kaplan-Meier曲线计算各评分不同危险组患者1年卒中复发率。结果 SRS评分对30d、90d、180d和1年内卒中复发均能适度预测(C-statistics分别为0.638,0.619,0.626,0.615)。虽然ESRS评分对30d和1年内卒中复发能适度预测(C-statistics分别为0.617,0.608),但对90d和180d内卒中复发预测差(C-statistics分别为0.583,0.572)。由SRS和ESRS评估为危险组的患者有类似的1年卒中复发风险(分别为17.0%,15.5%)(P>0.05),而低危组1年复发风险相同(8.2%)。结论 SRS评分对缺血性卒中后早中期卒中复发风险有适度预测能力,SRS评分对有较高脑卒中复发风险患者区别能力较ESRS评分稍高。缺血性卒中后风险预测仍需进一步可靠研究。

Objective The Essen stroke risk score （ESRS） had poor ability to distinguish patients with high-risk of stroke recurrence. We aimed to develop a modified ESRS, Stroke Risk Score （SRS）, to enhance the discrimination capability of ESRS and validated it in ischemic stroke patients. Methods The SRS was calculated from scores for atrial fibrillation, hyperglycemia, admission elevated blood pressure 140/90 mm Hg, carotid imaging, C-reactive protein （ CRP ）, fibrinogen （ FIB ）, homocysteine （Hcy）, low-density lipoprotein cholesterol （ LDL-C ） in addition to ESRS. C-statistics indicated predictive value. The 1 year risks of recurrent stroke were determined in relation to each score. Results The SRS was modestly predictive for 30 d, 90 d, 180 d and 1 year risks of recurrent stroke （c-statistics, 0.638, 0.619, 0.626, 0.615, respectively）. ESRS was modestly predictive for 30 d and 1 year risks of recurrent stroke （c-statistics, 0.617, 0.608, respectively）, but poorly predictive for 90 d and 180 d risks （c-statistics, 0.583, 0.572, respectively）. Patients in risk groups assessed by ESRS and SRS had similar I year risks of recurrent stroke （17.0%, 15.5%, respectively） （P 〉 0.05）, and patients in low-risk groups had the same 1 year risk （8.2%）. Conclusions The SRS was modestly predictive for early and medium-term risks of recurrent stroke after ischemic stroke. The SRS had slightly higher discrimination ability to identify patients with higher risk of recurrent stroke after ischemic stroke than ESRS. More reliable risk prediction after ischemic stroke is required.