颈动脉超声crouse斑块积分与急性脑梗死患者短期预后的关系及预测价值研究

Study on relationship between carotid artery ultrasound crouse plaque score and short-term prognosis of patients with acute cerebral infarction(ACI)and its predictive value

目的研究颈动脉超声crouse斑块积分与急性脑梗死(Acute cerebral infarction,ACI)患者短期预后的关系及预测价值。方法选取2022年11-2023年10月东莞市中医院功能检查科收治的ACI患者98例,均在入院时进行颈动脉超声检查,计算crouse斑块积分,随访3个月,采用改良Rankin量表(Modified Rankin scale,mRS)评估患者预后,≤2分者为预后良好,纳入对照组,>2分者为预后不良,纳入观察组。采用Logistic回归模型分析颈动脉超声crouse斑块积分与ACI患者短期预后的关系,绘制受试者工作曲线(Receiver operating characteristic curve,ROC)及校准曲线分析颈动脉超声crouse斑块积分预测ACI患者短期预后的价值。结果98例ACI患者随访3个月,失访3例,有效随访95例。mRS评分≤2分者59例,纳入对照组,预后良好率62.11%;>2分者36例,纳入观察组,预后不良率37.89%。与对照组比较,观察组年龄、梗死体积、神经功能受损程度、卒中相关肺炎比例、颈动脉超声crouse斑块积分增大(P<0.05)。在Logistic回归模型1中无调整因素条件下,颈动脉超声crouse斑块积分每增加1%,ACI患者短期预后不良发生风险增加3.361倍(P<0.05)。在Logistic回归模型2中调整年龄后,颈动脉超声crouse斑块积分每增加1%,ACI患者短期预后不良发生风险增加3.157倍。在Logistic回归模型3中调整年龄、梗死体积、神经功能受损程度、卒中相关肺炎后,颈动脉超声crouse斑块积分每增加1%,ACI患者短期预后不良发生风险增加3.099倍(P<0.05)。颈动脉超声crouse斑块积分预测ACI患者短期预后的AUC为0.876,95%CI为0.793~0.935,Youden指数最高值为0.716,敏感度、特异度分别为75.00%、96.61%。校准曲线显示,标准曲线与预测曲线贴合良好,Brier得分为0.039,校准斜率为0.974。结论颈动脉超声crouse斑块积分增加,ACI患者短期预后不良风险增加,可为临床预测ACI患者短期预后提供参考。

Objective:To investigate the relationship and predictive value of carotid ultrasound crouse plaque score in the short-term prognosis of the patients with acute cerebral infarction(ACI).Methods:A total of 98 patients with ACI admitted to the hospital from November 2022 to October 2023 were selected.All patients underwent carotid arteryultrasound examination upon the admission,and the crouse plaque score was calculated.After a 3-month follow-up,the prognosis of the patients were assessed using the modified Rankin scale(mRS).Thepatients with a score of≤2 were considered to have a good prognosis and included in the control group,while those with a score of>2 were considered to have a poor prognosis and included in the observation group.Logistic regression analysis was used to investigate the relationship between carotid arteryultrasound crouse plaque score and short-term prognosis in ACI patients.Receiver operating characteristic curve(ROC)and calibration curve were drawn to analyze the value of carotid ultrasound crouse plaque score in predicting the short-term prognosis of thepatients with ACI.Results:Of the 98 ACI patients followed up for 3 months,3 were lost to follow-up,resulting in 95 valid follow-ups.Among them,59 patients had an mRS score of≤2 and were included in the control group,with a good prognosis rate of 62.11%.The remaining 36 patients had an mRS score of>2 and were included in the observation group,with a poor prognosis rate of 37.89%.Compared with the control group,the age,infarct volume,degree of neurological impairment,proportion of stroke-associated pneumonia,and increased crouse plaque score in carotid arteryultrasound of the observation group were significantly different(P<0.05).In Logistic regression model 1,without adjustment for confounding factors,1%increase in carotid ultrasound crouse plaque score was associated with a 3.361-fold increase in the risk of short-term poor prognosis in ACI patients(P<0.05).After adjusting for age in Logistic regression model 2,1%increase in carotid arteryultrasound crouse plaque score was associated with a 3.157-fold increase in the risk of short-term poor prognosis in ACI patients.In Logistic regression model 3,after further adjusting for age,infarction volume,degree of neurological impairment,and stroke-related pneumonia,a 1%increase in carotid ultrasound crouse plaque score was associated with a 3.099-fold increase in the risk of short-term poor prognosis in ACI patients(P<0.05).The AUC of carotid arteryultrasound crouse plaque score in predicting short-term prognosis in ACI patients was 0.876,with a 95%CI ranging from 0.793 to 0.935.The maximum Youden index was 0.716,and the sensitivity and specificity were 75.00%and 96.61%,respectively.The calibration curve demonstrated a good fit between the standard curve and the prediction curve,with a Brier score of 0.039 and a calibration slope[JP2]of 0.974.Conclusion:An increase in carotid arteryultrasound crouse plaque score is associated with an increased risk of short-term poor prognosis in patients with ACI,providing a valuable reference for clinical prediction of short-term outcome in the patients.