mPASS评分对急性前循环大动脉闭塞性脑梗死的预测价值

Modified prehospital acute stroke severity scale in prediction of anterior circulation large-vessel occlusion stroke

目的探究改良院前急性卒中严重程度量表(mPASS)评分对急性前循环大动脉闭塞性脑梗死的预测价值。方法选择2016年1月至2018年1月在浙江大学医学院附属杭州市第一人民医院急诊的临床可疑前循环缺血性脑卒中患者419例。根据影像学诊断将患者分为急性大动脉闭塞性脑梗死组198例,急性非大动脉闭塞性脑梗死组221例。其中急性大动脉闭塞性脑梗死组患者除去3例大脑前动脉闭塞性脑梗死患者后再分为颈内动脉闭塞性脑梗死亚组94例和大脑中动脉闭塞性脑梗死亚组101例。采用ROC曲线分析mPASS评分对急性前循环大动脉闭塞性脑梗死的预测价值。以CT血管造影(CTA)或数字减影血管造影(DSA)结果为参照,分别评估mPASS、院前急性卒中严重程度量表(PASS)评分、美国国立卫生研究院卒中量表(NIHSS)评分对急性前循环大动脉闭塞性脑梗死、颈内动脉闭塞性脑梗死、大脑中动脉闭塞性脑梗死的预测价值。结果3种评估量表预测急性前循环大动脉闭塞性脑梗死均较好。mPASS评分的AUC显著高于PASS评分,低于NIHSS评分。mPASS评分在最佳截断值时的灵敏度和特异度均高于PASS评分。结论对于临床可疑急性前循环大动脉闭塞性脑梗死患者,尤其大脑中动脉闭塞性脑梗死,mPASS评分较PASS评分有更好的预测价值。

Objective To evaluate the predictive value of modified prehospital acute stroke severity severity(mPASS)for large vessel occlusion in anterior circulation.Methods The clinical data of 419 patients with suspected acute anterior circulation ischemic stroke within 24 h of onset who visited the Emergency Department of Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,from January 2016 to January 2018 were retrospectively analyzed,including 198 cases of large vessel occlusion(LVO)and 221 non-LVO cases.The ROC curve was used to analyze the predictive value of mPASS score for anterior circulation large-vessel occlusion stroke.The predictive values of mPASS,prehospital acute stroke severity(PASS)score,and NIHSS score for acute anterior circulation large vessel occlusive cerebral infarction,internal carotid artery occlusive cerebral infarction,and middle cerebral artery occlusive cerebral infarction were assessed,using CT angiography(CTA)or digital subtraction angiography(DSA)results as references.Results All three assessment scales could predict acute large vessel occlusion in anterior circulation well.The AUC of mPASS was significantly higher than that of PASS(P<0.05).The sensitivity and specificity of mPASS score at the optimal cut-off value were higher than those of PASS score.Conclusion The mPASS scale has a better prediction value for LVO than PASS scale;and it is better for predicting middle cerebral atrery occlusion than for internal carotid artery occlusion.