两种CT-ASPECTS评分在单侧大脑中动脉闭塞所致AIS患者预后评估中的应用价值

Application value of two CT-ASPECTS scores in prognosis evaluation of patients with AIS caused by unilateral middle cerebral artery occlusion

目的比较CT平扫(NCCT)、CTA源图像(CTA-SI)的阿尔伯塔卒中项目早期CT评分(ASPECTS)对单侧大脑中动脉(MCA)闭塞急性缺血性卒中(AIS)患者90 d预后的预测价值。方法回顾性分析105例单侧MCA闭塞AIS患者的临床资料,治疗前行两种CT-ASPECTS评分,以卒中后90 d临床预后情况为评价标准(定义mRS评分≤2分为预后良好),将患者分为预后不良组(n=51)与预后良好组(n=54)。使用ROC曲线分析两种CT-ASPECTS评分对患者预后的预测价值。结果预后不良组与预后良好组的发病时间、NCCT-ASPECTS评分及CTA-SI ASPECTS评分比较,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,CTA-SI ASPECTS预测患者预后良好的曲线下面积(AUC)为0.822,临界点为0.659,灵敏度为0.796,特异度为0.863;NCCT-ASPECTS评分预测患者预后良好的AUC为0.666,临界点为0.284,灵敏度为0.519,特异度为0.765。结论对于单侧MCA闭塞所致AIS患者,可依据NCCT-ASPECTS评分及CTA-SI ASPECTS评分预测患者预后,但CTA-SI ASPECTS评分的特异度和灵敏度更高。

Objective To compare the value of Alberta stroke program early CT score(ASPECTS)of non-contrast enhanced computerized tomography(NCCT)and computerized tomography angiography source image(CTA-SI)in predicting the prognosis at 90 d after stroke of patients with acute ischemic stroke(AIS)caused by unilateral middle cerebral artery(MCA)occlusion.Methods The clinical data of 105 AIS patients with unilateral MCA occlusion were retrospectively analyzed,and all patients were evaluated by two CT-ASPECTS scores before treatment.Taking the clinical prognosis at 90 d after stroke as the evaluation standard(defining mRS score≤2 points as good prognosis),the patients were divided into poor prognosis group(n=51)and good prognosis group(n=54).ROC curve was used to analyze the predictive value of the two CT-ASPECTS scores on the prognosis of patients.Results There were significant differences in the onset time,NCCT-ASPECTS score and CTA-SI ASPECTS score between the poor prognosis group and the good prognosis group(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of CTA-SI ASPECTS to predict a good prognosis for patients was 0.822,the cut-off point was 0.659,the sensitivity was 0.796,and the specificity was 0.863;the AUC of NCCT-ASPECTS score to predict a good prognosis for patients was 0.666,the cut-off point was 0.284,the sensitivity was 0.519,and the specificity was 0.765.Conclusion For patients with AIS caused by unilateral MCA occlusion,the prognosis can be predicted by NCCT-ASPECTS score and CTA-SI ASPECTS score,but the specificity and sensitivity of CTA-SI ASPECTS score are higher.