基于颈动脉高分辨磁共振成像的改良脑卒中风险评分模型对脑卒中患者再发风险的预测研究

A Study Of Carotid High-Resolution MR Imaging-Based Revised Stroke Risk Score in the Prediction of Recurrent Acute Ischemic Stroke

目的在Essen卒中风险评分量表(ESRS)模型基础上,结合颈动脉高分辨MR成像技术,建立改良脑卒中风险评分模型(RSRS)。方法回顾性分析41例缺血性脑卒中(AIS)初发和再发患者的临床及实验室指标,所有患者均行高分辨MR序列成像,对比初发及再发AIS患者颈动脉斑块负荷和成分的差别,并进行Logstic多因素回归分析,筛选出独立危险因素并逐步构建分层方案,联合ESRS形成改良的RSRS,利用ROC曲线评估ESRS及RSRS预测卒中再发的准确性。结果 (1)再发组与初发组AIS患者高血压、糖尿病、低密度脂蛋白(LDL-C)、总胆固醇(TC)、标准化管壁指数(NWI)、斑块内出血(IPH)比例、破裂的纤维帽(FCR)比例、富含脂质坏死核心(LRNC)最大面积/指数和IPH最大面积/指数组间差异均有统计学意义(P<0.05)。(2)LDL-C、IPH、FCR、NWI值及LRNC指数是AIS患者发生再发脑卒中的独立危险因素。(3)ROC曲线显示,ESRS及RSRS评分的曲线下面积分别为0.890和0.912,当RSRS评分=6分时,其敏感性及特异性最高。结论 ESRS和RSRS均对AIS再发有明确的预测价值,但改良后的RSRS预测价值更大;RSRS评分=6分可作为预测AIS再发风险的分层方案。

Objective To develop an optimized stroke risk score system from the revised stroke risk score（RSRS）based on the Essen Stroke Risk Score（ESRS） using carotid high-resolution magnetic resonance imaging（MRI）. Methods 41 patients with AIS,including initial and recurrent AIS,were enrolled in this study. All patients＇ clinical information,laboratory tests and radiological information were retrospectively analyzed. Carotid plaque high-resolution MR imaging was performed in all patients. The carotid plaque burden and compositional features were compared between the initial and recurrent stroke patients. All the potential risk components in relation to recurrent AIS were determined by multiple Logistic regression analysis. The best weighting scheme for all independent predictors were determined and enrolled into RSRS. The value of RSRS in prediction for recurrent AIS was compared with ESRS using a receiver operating characteristic curve（ROC）. Results（1） The prevalence of hypertension and diabetes mellitus,the level of low-density lipoprotein cholesterol（LDL-C） and total cholesterol（TC）,the mean NWI,the prevalence of fibrous cap rupture（FCR） and intra-plaque hemorrhage（IPH）,the max LRNC and index of LRNC,the max IPH and index of IPH were statistically significant between the two groups（all P〈0. 05）.（2） LDL-C,IPH,FCR,NWI and LRNC index were independent risk factors in prediction of recurrent AIS.（3） AUC of ESRS and RSRS was 0. 890 and 0. 912 using ROC,respectively. RSRS = 6 resulted in the highest sensitivity and specificity. Conclusion Both ESRS and RSRS were valuable in the prediction for recurrent AIS patients,but ESRS was much more valuable. RSRS = 6 was the critical value for the prediction of the high-risk population of recurrence.