NIHSS评分及肺部感染预测缺血性脑卒中晚期癫痫发作的价值评估

Assessment of the value of NIHSS score and lung infection in predicting late seizures in ischaemic stroke

目的分析缺血性脑卒中(IS)患者晚期癫痫发作的危险因素,并评估其预测价值。方法收集776例IS患者,根据是否出现晚期癫痫发作(LS),分为癫痫发作组28例(3.6%)和非癫痫发作组748例(96.4%),比较两组患者的一般临床信息资料、实验室检查及影像学资料。采用单、多因素Logistic回归分析IS晚期癫痫发作的独立危险因素,并通过受试者工作曲线(ROC)评估其预测价值。结果776例IS患者的年龄为(62.0±13.6)岁;与非癫痫发作组相比,癫痫发作组患者的NIHSS评分、脑皮质受累、动脉循环受累、肺部感染、血钠水平方面,比较差异均有统计学意义(^(均)P<0.05)。对以上差异性指标采用单、多因素Logistic回归分析,结果显示NIHSS评分(OR=1.119,95%CI1.046~1.197,P=0.001)、肺部感染(OR=3.455,95%CI 1.396~8.549,P=0.007)是IS患者晚期癫痫发作的独立危险因素,NIHSS评分联合肺部感染对IS患者癫痫发作的ROC曲线下面积为0.854(95%CI 0.790~0.917),敏感度为82.1%,特异度为77.0%;根据ROC曲线结果分析NIHSS评分>6.5分是预测IS患者晚期癫痫发作的最佳临界值。结论NIHSS评分>6.5分和伴有肺部感染是IS患者晚期癫痫发作的独立危险因素,两项指标联合可较好的预测患者的晚期癫痫发作状况。

Objective To analyse the risk factors for late-onset seizures in patients with ischaemic stroke(IS)and assess their predictive value.Methods 776 patients with IS were retrospectively collected and divided into 28(3.6%)in the seizure group and 748(96.4%)in the non-seizure group according to whether they presented with late seizures(LS),and the general clinical information data,laboratory tests and imaging data of the two groups were compared.Independent risk factors for late seizures in IS were analysed using simgle and multifactorial Logistic regression,and their predictive value was assessed by Receiver operating characteristic(ROC).Results The age of776 patients with IS was(62.0±13.6)years;the differences were statistically significant(^(all)P<0.05)in terms of NIHSS scores,cerebral cortical involvement,arterial circulatory involvement,pulmonary infections,and blood sodium levels in the patients in the seizure group as compared with those in the non-seizure group.Single and multifactorial Logistic regression analyses were used for the above differential indicators,and the results showed that NIHSS score(OR=1.119,95%CI 1.046-1.197,P=0.001)and lung infection(OR=3.455,95%CI 1.396-8.549,P=0.007)were the independent seizure in the late phase of IS patients risk factors,and the area under the ROC curve of NIHSS score combined with lung infection for seizures in ischemic stroke patients was 0.854(95%CI 0.790-0.917),with a sensitivity of 82.1%and a specificity of 77.0%;according to the analysis of the ROC curve results,NIHSS score>6.5 was the best prediction of late-onset seizures in IS patients.critical value.Conclusion NIHSS score>6.5 and concomitant lung infection are independent risk factors for late seizures in patients with IS,and the combination of these two indexes can better predict the status of late seizures in patients.