THRIVE评分对伴有心房颤动的急性缺血性卒中患者预后的预测价值

The role of THRIVE score in prediction of outcomes of acute ischemic stroke patients with atrial fibrillation

目的 探讨THRIVE评分对伴有心房颤动（房颤）的急性缺血性卒中患者预后的预测价值.方法 选取2009年9月至2013年3月苏州大学附属第二医院169例伴有房颤的急性缺血性卒中患者纳入研究,所有患者行美国国立卫生院神经功能缺损评分（NIHSS）、THRIVE评分及CHADS2评分,3个月后行改良Rankin评分（mRS）,根据THRIVE评分将患者分为1～3分、4～5分及6～9分3组,比较3组间基线差别及预后,采用Logistics多因素回归分析对THRIVE评分与患者预后关系进行评价.结果 （1）169例患者中,THRIVE评分1～3分组59例（34.9％）,4～5分组71例（42.0％）,6～9分组39例（23.1％）.随着THRIVE评分的增加,患者年龄（F =31.360,P＜0.001）及空腹血糖水平（F =12.410,P＜0.001）逐步增高,3组比较差异有统计学意义.（2）随着THRIVE评分逐渐增高,患者3个月后良好预后的比例逐渐降低（x2=48.259,P=0.000）,病死率（x2=36.754,P＜0.001）及肺部感染发生率（x2=16.590,P=0.000）逐渐增高,而3组之间颅内出血转化发生率无明显差别（x2=2.064,P=0.356）.（3） ROC曲线分析显示,THRIVE评分对患者不良预后、死亡及肺部感染的预测效果均明显优于CHADS2评分（AUCROC=0.797,P＜0.001比AUCROC=0.579,P=0.085;AUCROC =0.796,P ＜0.001比AUCROC =0.569,P =0.198;AUCROC =0.708,P ＜0.001比AUCROC=0.573,P=0.152）.（4）多因素回归分析显示,THRIVE评分是伴有房颤的缺血性卒中患者3个月后良好预后（OR=0.406,P＜0.001）、死亡（OR=2.083,P＜0.001）及住院期间肺部感染（OR=2.168,P＜0.001）的独立预测因子.结论 THRIVE评分与伴有房颤的急性缺血性卒中患者3个月后良好预后呈明显负相关,与3个月后死亡及住院期间肺部感染呈明显正相关,表明THRIVE评分对伴有房颤的缺血性卒中患者的预后及并发症具有良好的预测价值.

Objective To study whether the totaled health risks in vascular events （THRIVE） score could predict the prognosis in the acute ischemic stroke patients with atrial fibrillation.Methods A total of 169 patients were enrolled in the study,with NIH Stroke Scale （NIHSS） score,THRIVE score and CHADS2 score given to each patients at admission and modified Rankin Scale （mRS） given at 3 months follow up.All patients were divided into the following 3 groups according to their THRIVE score：1-3 score group,4-5 score group and 6-9 score group.Results （1） There were 59 patients （34.9%） in the 1-3 score group,71 patients （42.0%） in the 4-5 score group and 39 patients （23.1%） in the 6-9 score group.As the THRIVE score increased,significant difference was observed among the 3 groups in the mean age （F =31.360,P =0.000） and the level of fasting glucose （F =12.410,P =0.000）.（2） As the THRIVE score increased in the 3 groups,the percentage of good prognosis in 3 months was significantly reduced （x2 =48.259,P 〈 0.001）,while the percentage of death and pulmonary infection were significantly increased （x2 =36.754,P 〈 0.001 ; x2 =16.590,P 〈 0.001,respectively）.No significant difference was found in the percentage of intracerebral hemorrhage （ICH） among the 3 groups （x2 =2.064,P =0.356）.（3） In the receiver operating characteristic （ROC） curve analysis,the THRIVE score was superior than the CHADS2 score in predicting poor prognosis （AUCROC =0.797,P 〈 0.001 vs AUC ROC =0.579,P =0.085）,death （AUCROC =0.796,P 〈 0.001 vs AUCROC =0.569,P =0.198） and pulmonary infection （AUCROC =0.708,P 〈0.001 vs AUCROC =0.573,P =0.152）.（4） Multifactor regression analysis suggested that the THRIVE score was an independent risk factor for good prognosis （OR =0.406,P =0.000）,death （OR =2.083,P =0.000） and pulmonary infection （OR =2.168,P =0.000）.Conclusions In the acute ischemic stroke patients with atrial fibrillation,the THRIVE score negatively correlates with good prognosis,while positively correlates with death and pulmonary infection.The THRIVE score could strongly predict the clinical outcomes in those patients.