颈-脑动脉僵硬度对急性缺血性卒中患者神经功能预后的预测价值

Predictive value of cervical-brain arterial stiffness in functional outcome of patients with acute ischemic stroke

目的探讨颈-脑动脉僵硬度对急性缺血性卒中患者神经功能预后的预测价值。方法回顾性分析2016年11月—2018年11月因急性缺血性卒中在我院住院治疗的226例患者,根据出院后3个月改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分≤2分,153例)和预后不良组(mRS评分>2分,73例)。应用超声经颅多普勒血流分析仪测定患者的颈-脑动脉脉搏波速度(ccPWV),对比2组患者脑卒中危险因素、临床资料及脑卒中类型的差异。多因素Logistic回归分析患者预后的影响因素。利用受试者工作特征(ROC)曲线评估ccPWV对急性缺血性卒中预后的预测价值。结果预后良好组患者年龄,危险因素比例(高血压、糖尿病、吸烟及冠心病),入院时美国国立卫生研究院卒中量表(NIHSS)评分及ccPWV低于预后不良组(P<0.05)。ccPWV预测急性缺血性脑卒中患者的预后的ROC曲线下面积为0.881,最佳临界值为6.79 m/s,敏感度为83.84%,特异度为76.69%。多因素Logistic回归分析的结果显示,NIHSS评分≥6分(OR=6.588,95%CI:2.197~15.342)、ccPWV≥6.79 m/s(OR=2.638,95%CI:1.367~5.647)、高血压(OR=2.146,95%CI:1.079~3.254)、糖尿病(OR=2.014,95%CI:1.403~5.341)、冠心病(OR=5.349,95%CI:3.246~18.298)及年龄≥70岁(OR=2.341,95%CI:1.579~6.241)均是急性缺血性脑卒中患者神经功能预后不良的独立危险因素。结论ccPWV≥6.79 m/s可能提示急性缺血性脑卒中患者神经功能预后不良。

Objective To investigate the predictive value of cervical-brain arterial stiffness in functional outcomes in patients with acute ischemic stroke.Methods A retrospective analysis was performed on 226 patients admitted to our hospital for acute ischemic stroke from November 2016 to November 2018.The patients were divided into good prognosis groups based on the mRS score 3 months after discharge(mRS score≤2 points,153 cases)and poor prognosis group(mRS score>2 points,73 cases).Ultrasound transcranial Doppler blood flow analyzer was used to measure the carotid-cerebral pulse wave velocity(ccPWV)of patients,and the differences in stroke risk factors,clinical data and stroke types were compared between the two groups.Multivariate Logistic regression analysis were used for influential factors on patients prognosis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of ccPWV for poor prognosis of acute ischemic stroke.Results The age,the proportion of risk factors(hypertension,diabetes,smoking and coronary heart disease),the National Institute of Health Stroke Scale(NIHSS)and ccPWV were lower in poor prognosis group than those at admission.In the poor prognosis group,the difference was statistically significant(P<0.05).The area under the ROC curve of ccPWV predicting the prognosis of patients with acute ischemic stroke was 0.881,the best cutoff value was 6.79 m/s,the sensitivity was 83.84%,and the specificity was 76.69%.The results of multivariate Logistic regression analysis showed that the NIHSS score was≥6 points(OR=6.588,95%CI:2.197-15.342),ccPWV≥6.79 m/s(OR=2.638,95%CI:1.367-5.647),hypertension(OR=2.146,95%CI:1.079-3.254),diabetes(OR=2.014,95%CI:1.403-5.341),coronary heart disease(OR=5.349,95%CI:3.246-18.298),and age≥70 years(OR=2.341,95%CI:1.579-6.241)were independent risk factors for poor prognosis in patients with acute ischemic stroke.Conclusion ccPWV≥6.79 m/s indicates poor prognosis in patients with acute ischemic stroke.