Zhongguo cuzhong zazhi (Jun 2022)
卒中预后量表对前、后循环缺血性卒中短期预后不良的预测价值研究 Validity Comparison of Stroke Prognosis Scales in Patients with Anterior or Posterior Circulation Ischemic Strok
Abstract
目的 通过比较不同卒中预后量表预测前、后循环急性缺血性卒中患者发病3个月预后的效度，为不同类型缺血性卒中寻找能够更准确预测预后的评分工具，以期更好地辅助临床决策。 方法 纳入中国国家卒中登记研究Ⅲ中的急性缺血性卒中患者，收集人口学信息、血管危险因素、颅影像学检查结果、病因分型等临床资料，发病3个月随访，以mRS≥3分为预后不良。使用洛桑急性卒中登记量表（acute stroke registry and analysis of Lausanne，ASTRAL）、血管事件总体健康风险量表（totaled health risks in vascular events，THRIVE）以及优化的THRIVE量表（THRIVE-C）预测患者的临床结局。绘制ROC曲线并采用C值表示AUC，通过比较C值探讨不同预后量表对前、后循环缺血性卒中患者3个月预后不良的预测效度。 结果 研究最终纳入11 286例急性缺血性卒中患者，前循环、后循环、前循环合并后循环缺血性卒中患者分别为6981例、3537例和768例，3个月预后不良的患者1681例。ASTRAL、THRIVE及THRIVE-C量表预测整体缺血性卒中患者3个月预后不良的C值分别为0.790（0.779～0.802）、0.682（0.668～0.696）、0.706（0.692～0.720）；预测前循环缺血性卒中预后不良的C值分别为0.796（0.781～0.811）、0.689（0.672～0.706）、0.707（0.690～0.724）；预测后循环缺血性卒中预后不良的C值分别为0.767（0.741～0.793）、0.668（0.640～0.696）、0.701（0.672～0.730）；预测前循环合并后循环组缺血卒中预后不良的C值分别为0.790（0.750～0.829）、0.668（0.621～0.715）、0.696（0.648～0.743）。ASTRAL在各缺血性卒中类型中对预后不良的预测效力均高于THRIVE和THRIVE-C（均P＜0.001）。 结论 ASTRAL、THRIVE及THRIVE-C量表均可有效预测急性缺血性卒中患者3个月预后不良，但是不同量表在前、后循环缺血性卒中人群的预测效力不同。 Abstract: Objective To compare the validity of different stroke prognosis scales in predicting the 3-month prognosis of patients with acute anterior or posterior circulation ischemic stroke, to find a suitable scale for different stroke subtypes and better assist clinical decision-making. Methods Patients with acute ischemic stroke from China National Stroke Registration Ⅲ were included in this study. The clinical data such as demographic information, vascular risk factors, head MRI results and etiological classification of stroke were collected. Poor prognosis was defined as a mRS score of 3 to 6 at 3-month follow-up. The clinical outcome of patients was predicted by the Lausanne stroke registry and analysis of Lausanne (ASTRAL) score, the totaled health risks in vascular events (THRIVE) and the optimized THRIVE scores (THRIVE-C). The ROC curve was drawn and the AUC was expressed by C value. The predictive validity of different predictive scales in patients with anterior or posterior circulation ischemic stroke were compared by C value. Results A total of 11 286 patients were included in this study, with 6981 cases with anterior circulation ischemic stroke, 3537 with posterior circulation ischemic stroke, and 768 with anterior and posterior circulation ischemic stroke. There were 1681 patients had poor clinical outcome at 3-month follow-up. The C value (95%CI) of ASTRAL, THRIVE and THRIVE-C scores for predicting the 3-month prognosis of patients with total ischemic stroke were 0.790 (0.779-0.802), 0.682 (0.668-0.696), 0.706 (0.692-0.720), respectively; that for patients with anterior circulation ischemic stroke were 0.796 (0.781-0.811), 0.689 (0.672-0.706) and 0.707 (0.690-0.724), respectively; and that for patients with posterior circulation ischemic stroke were 0.767 (0.741-0.793), 0.668 (0.640-0.696) and 0.701 (0.672-0.730), respectively; and that for patients with anterior and posterior circulation ischemic stroke were 0.790 (0.750-0.829), 0.668 (0.621-0.715) and 0.696 (0.648-0.743), respectively. The ASTRA score can better predict the 3-month prognosis of all types of ischemic stroke than THRIV and THRIVE-C score (both P<0.001). Conclusions The ASTRAL score, THRIVE score and THRIVE-C score can effectively predict the 3-month prognosis of patients with acute ischemic stroke, while different predictive scores had different predictive validity for patients with acute ischemic stroke.
Keywords
