4种量表对急性缺血性卒中桥接治疗不良预后的预测分析

Predictive value of 4 scores for poor prognosis after bridge treatment with acute ischemic stroke

目的比较Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)及致密动脉、改良Rankin量表、年龄、血糖、介入治疗时间和美国国立卫生研究院卒中量表[dense artery,modified Rankin scale(mRS),age,glucose,onset-to-treatment time and National Institute of Health stroke scale(NIHSS),DRAGON]评分及血管事件总体健康风险量表(totaled health risks in vascular events,THRIVE)及血糖、早期梗死征、致密层、年龄和美国国立卫生研究院卒中量表(sugar,early infarct signs,dense artery,age and NIHSS,SEDAN)评分,对北京市顺义区颅内大血管闭塞所致急性缺血性卒中静脉溶栓桥接机械取栓治疗患者3个月不良预后的预测价值。方法回顾性连续收集2020年1月1日至2022年1月1日北京市顺义区医院急诊收入院的接受静脉溶栓并机械取栓桥接治疗且经证实为前循环颅内大血管闭塞所致急性缺血性卒中(acute ischemic stroke,AIS)患者,共58例,分别对患者使用ASPECTS、DRAGON、THRIVE评分和SEDAN量表进行评分,以卒中后3个月临床预后为观察终点,应用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析各评分对3个月不良预后的预测价值。结果22例患者预后不良,两组间介入24h的NIHSS评分、血糖、CT血管高密度征差异有统计学意义(P<0.05);其中ASPECTS、DRAGON、SEDAN评分在两组间差异有统计学意义。ROC曲线分析显示,ASPECTS、DRAGON、SEDAN评分的曲线下面积(area under the curve,AUC)分别为0.724、0.753、0.715。结论ASPECTS、DRAGON和SEDAN评分可预测颅内大血管闭塞致急性缺血性卒中桥接治疗3个月不良预后的风险。

Objective The aim of this study was to investigate the predictive value of Alberta stroke program early CT score(ASPECTS),dense artery,modified Rankin scale(mRS),age,glucose,onset-to-treatment time and National Institute of Health stroke scale(NIHSS)(DRAGON),totaled health risks in vascular events(THRIVE)and sugar,early infarct signs,dense artery,age and NIHSS(SEDAN)scores on the adverse prognosis at 3 months after intravenous thrombolysis bridge with mechanical thrombectomy.Methods Retrospective and continuous collection of 58 patients who underwent intravenous thrombolysis and mechanical thrombectomy bridging treatment from January 1,2020 to January 1,2022 at the Emergency Department of Shunyi District Hospital in Beijing,and were confirmed to be acute ischemic stroke(AIS)patients caused by anterior circulation intracranial vascular occlusion.The patients were scored using ASPECTS,DRAGON,THRIVE scores,and SEDAN scales,with clinical prognosis at 3 months after stroke as the observation endpoint,Apply receiver operating characteristic(ROC)curve to analyze the predictive value of each score for a 3 months adverse prognosis.Results The prognosis of 22 patients was poor,and there was a statistically significant difference in 24-hour NIHSS score,blood glucose,and CT vascular high-density sign between the two groups(P<0.05).The ASPECTS,DRAGON,and SEDAN scores showed statistically significant differences between the two groups.ROC curve analysis showed that the area under the curve(AUC)of ASPECTS,DRAGON,and SEDAN scores were 0.724,0.753,and 0.715.Conclusion ASPECTS,DRAGON,and SEDAN scores can predict the risk of poor prognosis after 3 months of bridging treatment for acute ischemic stroke caused by intracranial vascular occlusion.