ASTRAL评分对急性前后循环脑梗死预后预测价值的比较

Role of ASTRAL score in predicting prognosis of anterior and posterior circulation acute cerebral infarction

目的探讨ASTRAL评分对急性前后循环脑梗死预后的预测价值。方法收集我院神经内科住院的急性脑梗死（ACI）患者692例,根据头颅MRI结果分为前循环ACI组（481例）和后循环ACI组（211例）,患者入院24h内进行ASTRAL评分。以发病30d预后为研究终点,预后良好定义为改良的Rankin量表（mRS）评分0~2分,预后不良定义为mRS评分3~5分或死亡。通过ROC曲线分析ASTRAL评分对前后循环ACI预后的预测价值。结果前循环ACI组预后不良为81例,后循环ACI组预后不良44例。前循环ACI组和后循环ACI组预后良好患者ASTRAL评分均低于预后不良患者,差异有统计学意义[（17.30±3.66）分vs（26.81±7.90）分,（17.25±4.11）分vs（23.66±7.28）分,P〈0.01]。随着ASTRAL分值的增加,2组患者不良预后的比例均明显上升。ASTRAL评分预测前循环ACI组和后循环ACI组预后不良的ROC曲线下面积分别为0.902和0.788（P〈0.01）,最佳界值分别为22分和19分,其对应的敏感性分别为79.0%和72.7%,特异性分别为88.2%和68.9%。结论 ASTRAL评分可能是预测ACI患者1个月不良预后的实用工具,ASTRAL评分对前循环ACI预后的预测价值更好。

Objective To study the role of ASTRAL score in predicting the prognosis of anterior and posterior circulation acute cerebral infarction（ACI）.Methods Six hundred and ninety-two ACI patients were divided into anterior circulation ACI group（n=481）and posterior circulation ACI group（n=211）according to their head MRI.Patients were assessed with a ASTRAL score within 24 hours after admission.The outcome of the 30 day of onset was the end of the study.Good prognosis was defined when the mRS score was 0-2and poor prognosis was defined when the mRS score was 3-5.The role of ASTRAL score in predicting the prognosis of anterior and posterior circulation ACI was analyzed according to its ROC curve.Results There were 81 anterior circulation patients with poor prognosis,and there were 44 posterior circulation infarction patients with poor prognosis.The ASTRAL score was lower in ACI patients with a good prognosis than in those with a poor prognosis（17.30±3.66 vs 26.81±7.90,17.25±4.11 vs 23.66±7.28,P0.01）.The rate of poor prognosis increased with the increasing ASTRAL score.The area under the ROC curve for ASTRAL was 0.902 and 0.788 respectively.The best cut-off points was 22 and 19respectively.The sensitivity of anterior circulation and posterior circulation infarction was79.0% and 72.7% respectively,and the specificity was 88.2% and 68.9% respectively.Conclusion ASTRAL score can predict the poor prognosis of ACI patients.