NIHSS评分对急性脑梗死颅内大动脉闭塞的预测价值

Predictive value of the NIHSS for intracranial main artery occlusion in patients with acute cerebral infarction

目的探讨急性脑梗死患者NIHSS评分与大动脉闭塞之间的关系,并分析该评分对动脉闭塞是否具有预测价值。方法前瞻性登记急性脑梗死患者211例,其中178例符合入组标准。依据头颅MRA判定大动脉是否闭塞,将患者分为动脉闭塞组及非动脉闭塞组,并应用NIHSS评分评估患者神经功能缺损程度。采用受试者操作特征(ROC)曲线验证NIHSS评分预测动脉闭塞的有效性并确定其最佳截断点。结果头颅MRA显示,动脉闭塞组35例(19.66%),NIHSS评分中位数为3(IQR 2-10),非动脉闭塞组143例(80.34%),NIHSS评分中位数为2(IQR 1-4),动脉闭塞组NIHSS评分明显高于非动脉闭塞组(P<0.05)。ROC曲线结果提示,NIHSS评分预测动脉闭塞的有效性在临床评估时间<6h时较高,曲线下面积为0.829(P<0.05),NIHSS评分最佳截断点为7.5(灵敏度83.3%,特异度95.0%)。临床评估时间超过6h时,NIHSS评分的预测价值下降(P>0.05)。结论 NIHSS评分预测急性脑梗死颅内大动脉闭塞的有效性呈时间依赖性,临床评估时间在发病6h内预测价值较高,随着评估时间的延长而降低。

Objective To investigate the relationship between NIHSS scores and main artery occlusion in acute cerebral infarction patients, and analyze whether the score has predictive value for artery occlusion. Method 211 cases of acute cerebral infarction patients were collected to the prospective stroke database. 178 patients met the inclusion criteria. According to magnetic resonance angiography （ MRA ） judged whether main artery occlusion exists, patients were divided into two groups： artery, occlusion group and non- artery occlusion group. Using NIHSS score assessed the neurological deficit. Draw receiver operating characteristic （ ROC ） curve to verify the effective time of predicting artery, occlusion by NIHSS score and to determine its optimal cut-off point. Results The brain MRA showed arlez-y occlusion group 35 cases （ 19.66% ） , median NIHSS score was 3 （ IQR 2-10 ） ; and non- artery occlusion group 143 cases （ 80.34% ） , median NIHSS score was 2 （ IQR 1-4 ） , NIHSS score in artery occlusion group was significantly higher than that in non- artery occlusion group （ P〈0.05 ） . ROC curve results suggested that the validity of the NIHSS to predict artery occlusion was higher at the clinical evaluation time 〈 6h, the area trader the curve was 0.829 （ P〈O.05 ） .The best cut-off point of NIHSS score was 7.5 （ sensitivity 83.3%, specificity 95.0% ） . When the clinieal evaluation time 〉I 6h, the predictive value of NIHSS score was declased （ P〉O.05 ） . Conclusion The validity of the NIHSS for predicting artery occlusion in acute cerebral infarction is time-dependent. The predictive value is higher within 6 h of symptom onset, decreasing with increasing time from symptom onset to clinical evah,ation.