NIHSS评分结合CT血管成像对超早期急性缺血性脑卒中临床预后的预测作用分析

Analysis of the predictive role of NIHSS score combined with CT angiography on the clinical prognosis of ultra-early acute ischemic stroke

目的 超早期急性缺血性脑卒中患者应用美国国立卫生研究院卒中量表(NIHSS)评分以及CT血管成像(CTA)相结合方式进行临床诊断,评估该诊断方式对患者临床预后的预测价值。方法 选取100例超早期急性缺血性脑卒中患者进行研究,以临床治疗后NIHSS评分为评判标准将患者分为预后良好组(NIHSS评分≤4分, 52例)和预后不良组(NIHSS评分>4分, 48例)。对比两组患者预后情况、NIHSS评分以及CT血管成像显示阻塞情况,分析超早期急性缺血性脑卒中患者临床预后的单因素及多因素,分析超早期急性缺血性脑卒中临床预后的受试者工作特征曲线(ROC)。结果 预后良好组患者基线NIHSS评分、出院时NIHSS评分、神经功能恢复率分别为(6.1±1.5)分、(2.4±0.5)分、(0.67±0.12),预后不良组分别为(11.8±2.3)分、(6.8±1.3)分、(0.46±0.19)。与预后不良组比较,预后良好组患者基线NIHSS评分、出院时NIHSS评分均明显更低,神经功能恢复率明显较高(P<0.05)。单因素分析结果显示,与预后不良组比较,预后良好组基线NIHSS评分及CT血管成像显示血管阻塞占比明显偏低(P<0.05)。多因素回归分析显示,基线NIHSS评分高、CT血管成像显示血管阻塞与超早期急性缺血性脑卒中早期临床预后密切相关,是超早期急性缺血性脑卒中临床预后的独立危险因素(P<0.05)。由ROC分析可知,NIHSS评分结合CT血管成像模型预测超早期急性缺血性脑卒中临床预后的敏感性和特异性均高于基线NIHSS评分模型和CT血管成像模型。结论 NIHSS评分结合CT血管成像对超早期急性缺血性脑卒中临床预后的预测能力突出。

Objective To evaluate the predictive value of National Institutes of Health Stroke scale(NIHSS)score combined with CT angiography(CTA)on the clinical prognosis of ultra-early acute ischemic stroke.Methods A total of 100 patients with ultra-early acute ischemic stroke were selected for this study,and the patients were divided into good prognosis group(NIHSS score≤4 points,52 cases)and poor prognosis group(NIHSS score>4 points,48 cases)according to NIHSS score after clinical treatment.The prognosis,NIHSS score and obstruction shown on CT angiography of patients with ultra-early acute stroke were compared between the two groups,and the single and multiple factors affecting the clinical prognosis of patients with ultra-early acute ischemic stroke were analyzed,and the receiver operating characteristic(ROC)curve of clinical prognosis of patients with ultra-early acute ischemic stroke was analyzed.Results The baseline NIHSS score,NIHSS score at discharge and neurological function recovery rate of patients with ultra-early acute ischemic stroke in the good prognosis group were(6.1±1.5)points,(2.4±0.5)points and(0.67±0.12),and those in the poor prognosis group were(11.8±2.3)points,(6.8±1.3)points and(0.46±0.19).Compared with the poor prognosis group,the good prognosis group had significantly lower baseline NIHSS scores and NIHSS scores at discharge,and significantly higher neurological function recovery rates(P<0.05).The results of univariate analysis showed that compared with the poor prognosis group,the baseline NIHSS score and the percentage of vascular obstruction shown on CT angiography were significantly lower in the good prognosis group(P<0.05).Multivariate regression analysis showed that high baseline NIHSS score and vascular obstruction shown on CT angiography were closely associated with early clinical prognosis of ultra-early acute ischemic stroke, and were independent risk factors for clinical prognosis of ultra-early acute ischemic stroke (P<0.05). As shown by ROC analysis, the sensitivity and specificity of NIHSS score combined with CT angiography model in predicting the clinical prognosis of ultra-early acute ischemic stroke were higher than that of baseline NIHSS score model and CT angiography model. Conclusion NIHSS score combined with CT angiography has outstanding predictive ability for the clinical prognosis of ultra-early acute ischemic stroke.