改良MRI-DRAGON评分在急性缺血性卒中血管内治疗后预后预测中的价值

The value of modified MRI-DRAGON score in predicting the outcome of acute ischemic stroke after endovascular treatment

目的探讨改良MRI-DRAGON评分在急性缺血性卒中血管内治疗后预后中的预测价值。材料与方法回顾性分析2020年1月至2021年12月在两家医院接受血管内治疗的急性缺血性卒中患者的临床和影像学资料,根据临床及影像变量对患者进行MRI-DRAGON评分和改良MRI-DRAGON评分并进行比较。在治疗后3个月采用改良Rankin量表评估患者预后(0~2分为预后良好;3~6分为预后不良)。Logistic回归分析计算MRI-DRAGON评分和改良MRI-DRAGON评分对卒中不良预后预测的C-统计值。应用受试者工作特征(receiver operating characteristic,ROC)曲线分别分析两种评分对患者预后的预测价值,采用DeLong检验比较两者的差异。结果共纳入95例患者,预后良好组49例,预后不良组46例。两组间MRI-DRAGON评分(Z=5.046,P=0.023)与改良MRI-DRAGON评分(Z=-4.429,P<0.001)均存在显著差异。Logistic回归分析显示改良MRI-DRAGON评分预测卒中不良预后的C-统计值明显高于MRI-DRAGON评分[0.87(95%CI:0.78~0.90)vs.0.77(95%CI:0.65~0.81)]。ROC曲线显示改良MRI-DRAGON评分预测卒中预后的曲线下面积明显高于MRI-DRAGON评分(0.889 vs.0.757;Z=-2.294,P=0.022),其敏感度和特异度分别达91.3%和87.3%。结论改良MRI-DRAGON评分较传统MRI-DRAGON评分可更有效地预测急性缺血性卒中患者血管内治疗后3个月的预后。

Objective:To investigate the predictive value of modified MRI-DRAGON score in the outcome of acute ischemic stroke after endovascular treatment.Materials and Methods:Cases of patients with acute ischemic stroke underwent endovascular treatment in the two hospitals from January 2020 to December 2021 were enrolled retrospectively.Modified MRI-DRAGON and MRI-DRAGON score were evaluated and compared according to the clinical and MRI variables.The outcome at 3 month was evaluated with the modified Rankin Scale(mRS)at 3 months after treatment(0-2 points for good outcome and 3-6 points for poor outcome).Logistic regression analysis was used to calculate the C-statistic value of MRI-DRAGON score and modified MRI-DRAGON score in predicting poor outcome of stroke.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of two methods for outcome,and the difference was compared by DeLong test.Results:A total of 95 patients were included,including 49 patients with good outcome and 46 patients with poor outcome.There was significant difference between the MRI-DRAGON score(Z=5.046,P=0.023)and modified MRI-DRAGON score(Z=-4.429,P<0.001)between two groups.Logistic regression analysis showed that the modified MRI-DRAGON score was significantly higher than MRI-DRAGON score[0.87(95%CI:0.78-0.90)vs.0.77(95%CI:0.65-0.81)]in predicting poor outcome of stroke.ROC curve showed that the area under the curve of modified MRI-DRAGON score was significantly higher than that of MRI-DRAGON score in predicting poor outcome of stroke(0.889 vs.0.757;Z=-2.294,P=0.022),and its sensitivity and specificity reached 91.3%and 87.3%,respectively.Conclusions:Comparing with the traditional MRI-DRAGON score,the modified MRI-DRAGON score can more effectively predict the clinical outcome of patients with acute ischemic stroke at 3 months after endovascular treatment.