改良CPSSS量表对急性前循环大血管闭塞性脑梗死的预测价值分析

Analysis on the Predictive Value of Modified Cincinnati Prehospital Stroke Severity Scale for Acute Large Vessel Occlusion in Anterior Circulation

目的在辛辛那提院前卒中严重程度量表(Cincinnati prehospital stroke severity scale,CPSSS)基础上加入心房颤动项目构建改良CPSSS(modified CPSSS,mCPSSS),评估mCPSSS对急性前循环大血管闭塞(large vessel occlusion,LVO)的预测能力。方法回顾性分析2019年5月-2020年4月在重庆医科大学附属永川医院国家高级卒中中心就诊的急性前循环脑梗死患者的临床资料,运用单因素和二元logistic回归分析检验CPSSS量表项目及心房颤动与LVO的相关性,构建加入心房颤动指标的mCPSSS。通过ROC曲线及曲线下面积(areas under the curve,AUC)评估mCPSSS及CPSSS,视野、失语、忽视量表(vision,aphasia,neglect,VAN),三项内容卒中量表(3 item stroke scale,3I-SS)和快速动脉闭塞量表(rapid arterial occlusion evaluation,RACE)等卒中量表对前循环LVO的预测价值。结果共纳入263例患者。凝视、意识水平及提问、上肢无力、心房颤动是前循环LVO的独立预测因素。将心房颤动纳入CPSSS,并根据ROC曲线分析结果将其取值为1分(心房颤动取值1分,AUC=0.955;心房颤动取值2分,AUC=0.950)。mCPSSS总分≥2分预测前循环LVO的灵敏度为90.16%,特异度为94.33%。mCPSSS的预测价值高于CPSSS、VAN、3I-SS和RACE量表(均P<0.05,DeLong’s检验)。结论mCPSSS量表对前循环LVO的预测价值优于其他常用卒中量表,可能有助于急性前循环LVO患者的院前识别、急救及院内分诊。

Objective To modify Cincinnati prehospital stroke severity scale(CPSSS)by adding atrial fibrillation(AF),and evaluate the predictive value of modified CPSSS(mCPSSS)for large vessel occlusion(LVO)in anterior circulation.Methods This retrospective analysis enrolled the patients with acute ischemic stroke in anterior circulation in Comprehensive Stroke Center,Yongchuan Hospital of Chongqing Medical University between May 2019 and April 2020.Univariate and multivariate logistic regression analysis were used to analyze the association of the items of CPSSS and AF with LVO,and the mCPSSS containing CPSSS and AF was formed.ROC curve and the area under the curve(AUC)were used to evaluate the predictive ability for LVO in anterior circulation of the mCPSSS,CPSSS and other stroke assessment scales such as vision,aphasia,neglect(VAN),3 item stroke scale(3 I-SS)and rapid arterial occlusion evaluation(RACE).Results A total of 263 patients were included in this study.Gaze deviation,consciousness and response,upper limb weakness and AF were independent predictors of LVO in anterior circulation.When the point value of AF was defined as 1 point,the AUC of m CPSSS was 0.955;when defined as 2 points,the AUC was 0.950.For m CPSSS,the optimal cut-off value for predicting LVO was 2 points,with a sensitivity of 90.16%and a specificity of 94.33%.The capability of predicting LVO in anterior circulation of m CPSSS was superior to CPSSS,VAN,3 I-SS and RACE scales(all P<0.05,Delong’s test).Conclusions For predicting LVO in anterior circulation,the m CPSSS was superior to the other common stroke scales,which can be used for pre-hospital identification,emergency and in-hospital triage of acute LVO in anterior circulation.