八种量表对急性脑梗死近期死亡的预测价值

Predictive value of eight rating scales in recent death for patients with acute ischemic stroke

目的评价急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、急性生理学及慢性健康状况评分Ⅲ(APACHEⅢ)、改良爱丁堡-斯堪的纳维亚评分(MESSS)、美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力(ADL)评分、格拉斯哥昏迷(GCS)评分和伴发疾病、既往史评分对急性脑梗死患者近期死亡的预测价值。方法于入院24 h内对399例急性脑梗死患者分别进行APACHEⅡ、APACHEⅢ、MESSS、NIHSS、ADL、GCS和伴发疾病、既往史评分,以1个月为界根据存活状况将其分为生存组和死亡组。用聚类分析方法对八种量表进行聚类分析,通过描绘受试者工作特征曲线(ROC曲线)分析其对急性脑梗死患者预后的真实性。结果与生存组比较,死亡组APACHEⅡ、APACHEⅢ、MESSS、NIHSS及伴发疾病评分显著升高,GCS及ADL评分显著降低(均P<0.01)。两组间既往史评分差异无统计学意义(P>0.05)。聚类分析结果显示,APACHEⅡ和APACHEⅢ归为一类,MESSS和NIHSS归为一类,ADL、GCS和伴发疾病评分各自形成一类。APACHEⅡ、APACHEⅢ、MESSS和NIHSS的ROC曲线下的面积两两比较差异无统计学意义(均Z<1.96)。APACHEⅡ预测急性脑梗死的最佳界值为12分,APACHEⅢ为29分,MESSS为25分,NIHSS为10分。结论APACHEⅡ、APACHEⅢ、MESSS、NIHSS评分对急性脑梗死患者的近期死亡有较好的预测价值。

Objective To evaluate the predictive value of acute physiology and chronic health evaluation Ⅱ（ APACHEⅡ） , acute physiology and chronic health evaluation Ⅲ（ APACHEⅢ） , modified Edinburgh-Scandinavia stroke scale（MESSS）, national institutes of health stroke scale（NIHSS）, activity of daily living（ADL）, Glasgow coma scale（GCS）, complication scale and past history scale in recent death for patients with acute ischemic stroke . Methods Three hundred and thirty-nine patients with acute ischemic stroke were tested with APACHEⅡ, APACHEⅢ, MESSS, NIHSS, ADL, GCS, complication scale and past history scale within 24 hours after admission.Patients were divided into survivor group and death group according to the status of survival or death after 1 month of morbidity.Using cluster analysis methods to analysis the eight rating scales , and evaluated the reality of them by making receiver operating characteristic （ ROC） curves.Results Compared with survivor group , the scores of APACHEⅡ, APACHEⅢ, NIHSS, MESSS and complication scale in death group were significantly higher , and the scores of ADL and GCS were significantly lower （ all P〈0.01 ） .There was no significant difference of past history scale between the two groups （P〉0.05）.The cluster analysis showed the MESSS and NIHSS were in the same class , APACHEⅡand APACHEⅢwere in the same class, and ADL, GCS, complication scale were belonged to one class respectively .Multiple comparison showed no significant difference of area under curve in ROC between APACHE Ⅱ, APACHEⅢ, MESSS and NIHSS（all Z〈1.96）.The optimal cut-off point of acute ischemic stroke of APACHEⅡwas at 12, while APACHEⅢwas at 29, MESSS was at 25, and NIHSS was at 10.Conclusion APACHEⅡ, APACHEⅢ, MESSS and NIHSS have good predictive value in recent death of patients with acute ischemic stroke .