【摘要】 目的 建立一个后循环缺血（PCI）相关眩晕症的风险评分系统，确定最佳临界值并验证其在老年人PCI相关眩晕症中的诊断价值。方法 本研究分成两步进行：首先在380例PCI相关眩晕症患者和380例按照年龄和性别匹配的对照组患者中，使用多因素Logistic回归分析影响PCI相关眩晕症的因素，并按照回归系数数值建立风险评分模型。然后在149例PCI相关眩晕症患者和328例对照组患者中进行验证，同时采用受试者工作特征曲线分析风险评分模型与ABCD2和Essen评分系统对PCI相关眩晕症的诊断效能。结果 （1）多因素Logistic回归分析结果显示，4种病史（高血压病、糖尿病、缺血性卒中和高脂血症）、6种症状（复视、构音困难、饮水呛咳、听力受损、单侧肢体无力和耳鸣）和3种体征（肢体感觉缺失、肢体共济失调和步态共济失调）共13种因素为影响PCI患者相关眩晕症的因素（均P<0.05），并纳入最终的诊断风险模型，分数范围为-6～32分，得分越高，诊断的可能性越大。（2）根据PCI风险评分，将患者分为3个亚组：低危组（-5～0分，风险<18.4%）、中危组（1～10分）和高危组（≥11分，风险>80.2%）。根据Youden指数，PCI评分系统诊断的最佳临界点为4分，其敏感度为92.2%，特异度为58.7%。受试者工作特征曲线分析结果显示，PCI评分系统的曲线下面积为0.846(95%CI:0.794～0.898)，显著高于ABCD2[0.752(95%CI:0.668～0.836)]和Essen评分系统[0.659(95%CI:0.569～0.748)]，差异均有统计学意义（DeLong检验P值分别为0.009、<0.001）。结论 PCI评分系统在PCI相关眩晕症预测中的诊断效果优于ABCD2和Essen评分系统。4分是该评分系统的诊断临界值，但PCI风险评分超过0分的老年患者应该接受进一步检查。更多还原

【Abstract】 Objective To establish a new risk score model for the diagnosis of posterior circulation ischemia(PCI) related vertigo, and to determine the optimal cut-off values and validate their diagnostic value in PCI-related vertigo in the elderly. Methods This study was conducted in two steps. Firstly, a risk score model was developed using multifactorial logistic regression analysis according to regression coefficient values in 380PCI-related vertigo patients and 380 control patients matched according to age and sex. It was then validated in 149 PCI-related vertigo patients and 328 control subjects. Receiver operating characteristic(ROC) curve was applied to analyze the diagnostic efficacy of the score model, ABCD2 and Essen scoring systems to PCI related vertigo. Results Multivariate logistic regression analysis showed that 13 factors including 4 kinds of medical history(hypertension, diabetes, ischemic stroke and hyperlipidemia), 6 kinds of symptoms(diplopia, dysarthria, choking on water, impaired hearing, unilateral limb weakness, and tinnitus) and 3 kinds of physical signs(limb sensory loss, limb ataxia and gait ataxia) were the influencing factors of PCI related vertigo(P<0.05), and included in the final diagnostic risk model, with score ranging from-6 to 32. The higher the score was, the more likely the diagnosis was. Based on the PCI risk score, patients were divided into 3 subgroups: low-risk(-5 to 0 points, risk is less than 18.4%), intermediate-risk(1 to 10 points), and high-risk （≥11 points, risk is greater than 80.2%）. According to Youden index, the optimal cut-off point of PCI scoring system was 4 points, with a sensitivity of 92.2% and a specificity of 58.7%. The area under the ROC curve of PCI scoring system was 0.846(95%CI:0.794 to 0.898), which was significantly higher than that of ABCD2 [0.752(95%CI:0.668 to 0.836)] and Essen scoring system [0.659(95%CI:0.569 to 0.748)](P values of Delong test were 0.009 and 0.001, respectively). Conclusions The PCI scoring system was superior to the ABCD2 and Essen scoring systems in diagnosing PCI-related vertigo. A score of 4 is the diagnostic threshold for this scoring system, but elderly patients with a PCI risk score above 0 should undergo further investigation.更多还原