基于CT血管造影的侧支循环评分方法比较研究

Comparison of collateral circulation scales by computed tomographic angiography

目的对临床常用的rLMC评分、Miteff评分和Tan评分进行比较，为侧支循环评估方法的选择提供依据。方法选取自2013年8月至2017年2月苏州大学附属第一医院住院治疗的115例急性缺血性脑卒中患者。采用rLMC评分、Miteff评分和Tan评分评估所有患者侧支循环．比较3种评分的信度及效度。随访患者出院3个月时改良Rankin量表评分（mRS），0-2分定义为预后良好，3-6分定义为预后不良。应用二分类Logistic回归分析确定影响急性缺血性脑卒中预后的独立相关因素。采用受试者工作特征（ROC）曲线比较3种评分对急性缺血性脑卒中预后的预测价值。结果3种评分的信度从高到低依次为rLMC评分（Kappa=0．871）、Tan评分（Kappa=0．842）、Miteff评分（Kappa=0．752）；复测信度从高到低依次为rLMC评分（Kappa=0．879）、Tan评分（Kappa=0．826），Miteff评分（Kappa=0．775）。效度从高到低依次为rLMC评分（f0．690）、Tan评分（F0．680）、Miteff评分（rs=650）。单因素和多因素分析结果均显示，rLMC评分（OR=1．325，95％CI=1．048-1．675，P=-0．019）、Tan评分（OR=2．938，95％ CI=1．115-7．744，n=-0．029）和Miteff评分（OR=2．698．95％CI=1．050～6．93l，P=0．039）定义的侧支循环与急性缺血性脑卒中预后相关。ROC曲线分析结果显示．rLMC评分、Tan评分和Miteff评分的曲线下面积从高到低依次为0．848、0．799、0．759，三者对预后的预测价值由大到小依次为rLMC评分、Tan评分、Miteff评分。结论（1）与Mitefr评分和Tan评分相比，rLMC评分的信度和效度高，真实可靠，对预后的预测价值更高。（2）3种评分定义的侧支循环均是急性缺血性脑卒中预后的独立预测因素。

Objective To compare the regional leptomeningeal （rLMC） scale scores, Miteff scale scores and Tan scale scores to provide the clinical basis for selecting collateral circulation evaluation methods. Methods One hundred and fifteen patients with acute ischemic stroke, admitted to our hospital from August 2013 to February 2017 were chosen in our study. The rLMC scale, Miteff scale, and Tan scale were used to evaluate the collateral circulations of each patient. The credibility and validity of these 3 scales were compared. Modified Rankin scale （mRS） scores at 3 months were followed by 0-2 for good prognosis and 3-6 for poor prognosis. Binary Logistic regression analysis was used to determine the independent prognostic factors of ischemic stroke. Receiver operating characteristic （ROC） curve was used to compare the predictive values of the 3 scales for prognoses of ischemic stroke. Results Intra-observer agreement of the 3 scales from the highest to the lowest was rLMC scale （Kappa=0.871）, Tan scale （Kappa=0.842）, and Miteff scale （Kappa=0.752）. The test-retest reliability of the 3 scales from the highest to the lowest was rLMC scale （Kappa=0.879）, Tan scale （Kappa=0.826）, and Miteffscale （Kappa=0.775）. The validity of the 3 scales from the highest to the lowest was rLMC scale （rs=0.690）, Tan scale （rs= 0.680）, and Miteff scale （r,=0.650）. Univariable and multivariable analyses showed that the results of collateral circulation defined by rLMC scale （OR=1.325, 95%CI=1.048-1.675, P=-0.019）, Tan scale （OR=2.938, 95%CI=1.115-7.744, ,~=-0.029） and Miteff scale （OR=2.698, 95%CI=1. 050-6.931, P=0.039） were associated with prognoses of acute ischemic stroke. ROC curve showed that the area under the curve of rLMC scale, Tan scale, and Miteff scale was 0.848, 0.799, and 0.759, respectively; there were significant differences among the 3 scoring methods in the area under the curve （P〈0.05）, indicating the predictive values of the three to the prognoses： rLMC scale〉Tan scale〉Miteff scale. Conclusions As compared with Miteff scale and Tan scale, rLMC scale has high intra-observer agreement and validity, and is reliable but complicated. The results of collateral circulation defined by these 3 scoring methods are associated with the prognoses of acute ischemic stroke.