不同脑卒中评估工具对急性大血管闭塞性脑梗死的预测价值

Value of different stroke assessment scales in predicting acute cerebral infarction due to large vessel occlusion

目的研究不同脑卒中评估工具对急性大血管闭塞(large vessel occlusion,LVO)脑梗死的预测价值。方法前瞻性纳入2017年7月~2019年12月成都市第三人民医院收治的发病<6 h的老年急性脑梗死患者207例,根据影像学血管评估结果将患者分为LVO组103例和非LVO组104例,比较2组美国国立卫生研究院卒中量表(NIHSS)、辛辛那提院前卒中严重程度评估量表(CPSSS)、卒中现场评估及分类转运量表(FAST-ED)、洛杉矶运动量表(LAMS)、3项内容卒中量表(3-ISS)、快速动脉闭塞量表(RACE)、院前急性卒中严重程度量表(PASS)评分的差异,采用ROC曲线评价各量表预测LVO价值。结果LVO组NIHSS、CPSSS、FAST-ED、LAMS、3-ISS、RACE和PASS评分明显高于非LVO组,差异有统计学意义(P=0.000)。绘制ROC曲线显示,7种量表的ROC曲线下面积(AUC)为0.784~0.852,各量表均能预测急性LVO脑梗死(P=0.000)。CPSSS、FAST-ED、3-ISS、RACE、PASS的AUC与NIHSS评分比较,差异无统计学意义(z=0.986、0.411、0.848、0.470和1.573,P>0.05),LAMS的AUC明显低于NIHSS评分,差异有统计学意义(z=2.337,P=0.019)。7种量表评估LVO的最佳临界值为2.0~12.0分,相对应的敏感性为73.8%~82.5%,特异性为75.0%~81.7%。结论各量表对LVO均有一定预测价值,CPSSS、FAST-ED、3-ISS、RACE、PASS预测价值与NIHSS相仿,但CPSSS、FAST-ED、3-ISS、PASS项目较少、耗时少,对快速识别LVO更有优势。

Objective To study the value of different stroke assessment scales in predicting acute cerebral infarction(ACI)due to large vessel occlusion(LVO).Methods Two hundred and seven ACI patients admitted to our hospital from July 2017 to December 2019 were divided into LVO group(n=103)and LVO-free group(n=104).The scores of NIHSS,CPSSS,FAST-ED,LAMS,3-ISS,RACE,and PASS were compared between the two groups.The value of different stroke assessment scales in predicting ACI due to LVO was analyzed by ROC curve analysis.Results The scores of NIHSS,CPSSS,FAST-ED,LAMS,3-ISS,RACE,and PASS were significantly higher in LVO group than in LVO-free group(P=0.000).ROC curve analysis showed that the AUC for the 7 stroke assessment scales in predicting ACI due to LVO was 0.784-0.852,indicating that the 7 stroke assessment scales can predict ACI due to LVO(P=0.000).No significant difference was detected in AUC for CPSSS,FAST-ED,3-ISS,RACE,PASS and NIHSS in predicting ACI due to LVO between the two groups(z=0.986、0.411、0.848、0.470 and 1.573,P>0.05).However,the AUC for LAMS was significantly smaller than that of NIHSS in predicting ACI due to LVO(z=2.337,P=0.019).The cut-off value of the 7 stroke assessment scales was 2.0-12.0 with a sensitivity of 73.8%-82.5% and a specificity of 75.0%-81.7%.Conclusion Different stroke assessment scales have a certain value in predicting ACI due to LVO.The value of CPSSS,FAST-ED,3-ISS,RACE and PASS is similar to that of NIHSS.However,the time of CPSSS,FAST-ED,3-ISS and PASS is shorter than that of NIHSS.CPSSS,FAST-ED,3-ISS and PASS are thus advantageous over NIHSS in identification of ACI due to LVO.