老年营养风险指数对脑卒中后神经功能预后的效能

Predictive efficacy of Geriatric Nutritional Risk Index on neurological outcome after stroke

目的 评价入院时老年营养风险指数(GNRI)预测脑卒中患者康复期(卒中后3个月)神经功能的效能。方法 2022年11月至2023年1月,温州市中医院住院缺血性脑卒中患者277例,根据卒中后3个月改良Rankin量表(mRS)评分分为预后良好组(n=195)和预后不良组(n=82),比较两组临床资料和GNRI。结果 与预后良好组相比,预后不良组GNRI显著降低(t=-9.569,P <0.001),高营养风险患者比例显著增多(χ2=68.861,P <0.001);预后不良病例营养风险更高(Z=65.406,P <0.001)。校正协变量后,高GNRI水平是卒中后3个月神经功能预后不良发生的独立保护因素(OR=0.895,95%CI 0.864~0.927,P <0.05),且发生神经功能不良预后的风险随着GNRI营养风险等级的增加而逐渐增大。GNRI、国立卫生研究院卒中量表(NIHSS)评分和体质量指数(BMI)的曲线下面积(AUC)分别为0.812 (Z=11.576,P <0.001)、 0.759 (Z=8.328,P <0.001)和0.594 (Z=2.716,P=0.007),GNRI和NIHSS联合效能更高(AUC=0.875,Z=17.389,P <0.001)。GNRI、NIHSS评分以及两者联合预测神经功能的敏感性分别为65.85%、76.83%和79.21%,特异性分别为81.54%、60.51%和82.95%。结论 入院时GNRI与卒中后3个月的神经功能密切相关。GNRI可以单独或联合NIHSS评分用来预测康复期的神经功能,是传统预测指标的有益补充。

Objective To evaluate the efficacy of Geriatric Nutritional Risk Index(GNRI)on admission on predicting neurological outcomes for stroke patients at the convalescence stage(three months after stroke).Methods A total of 277 inpatients with ischemic stroke in Wenzhou TCM Hospital of Zhejiang Chinese Medical University from November,2022 to January,2023 were divided into good outcome group(n=195)and poor outcome group(n=82)according to the score of modified Rankin Scale(mRS)three months after stroke.Their clinical data and GNRI were compared.Results Compared with the good outcome group,the poor outcome group showed a lower level of GNRI(t=-9.569,P<0.001),more proportion of patients with high nutritional risk(χ2=68.861,P<0.001).More cases with poor outcome were found with higher nutritional risk(Z=65.406,P<0.001).After covariate adjustment,higher level of GNRI was an independent protective factor for poor outcome three months after stroke(OR=0.895,95%CI 0.864 to 0.927,P<0.05),and the OR increased with the nutritional risk grade of GNRI(P<0.05).The area under the curve(AUC)of GNRI,score of NIHSS,and BMI were 0.812(Z=11.576,P<0.001),0.759(Z=8.328,P<0.001),and 0.594(Z=2.716,P=0.007),respectively;while the combination of GNRI and NIHSS was more effective(AUC=0.875,Z=17.389,P<0.001).The sensitivities of GNRI,NIHSS and the combination of the two in predicting neurological function were 65.85%,76.83%and 79.21%,respectively,and the specificities were 81.54%,60.51%and 82.95%,respectively.Conclusion GNRI on admission is associated with neurological function three months after stroke.GNRI can be used alone or in combination with NIHSS score to predict neurological outcome in the rehabilitation period,which is a useful complement to traditional predictors.