【作者】 杨雪；

【导师】 易兴阳；

【作者基本信息】 成都中医药大学 ， 神经病学， 2023， 硕士

【摘要】 目的在比较国内外7个量表对前循环大血管闭塞(large vessel occlusion,LVO)脑卒中预测性能的基础上,构建简便、准确性高的新型LVO预测模型,前瞻性验证新模型的预测性能。方法纳入就诊于德阳市人民医院前循环急性缺血性脑卒中(acute cerebral stroke,AIS)患者为研究对象,根据头部血管检查分为LVO组、非LVO组。在比较国内外7个预测量表及阅读文献的基础上筛选出35个预测因子。比较两组患者预测因子的差异,多元logistic回归分析得出LVO的独立危险因素,对独立危险因素赋值,构建出新模型。采用受试者工作特征曲线(receiver operator characteristic curve,ROC)评价新模型的预测价值,对比新模型与7个量表的准确性。前瞻性纳入95例前循环AIS患者,验证新模型对LVO的预测性能。结果1.共纳入409例前循环AIS患者,经头部血管检查有121例为LVO脑卒中,288例为非LVO脑卒中。多元logistic回归分析发现面瘫、凝视、失语、握力减退、风心病与LVO独立相关。2.对上述与LVO独立相关的预测因子根据有、无赋值1分、0分,构建的新模型包含面瘫、凝视、失语、握力减退、风心病5项。3.新模型曲线下面积(area under curve,AUC)为0.799,最佳截断值为1.5,敏感性、特异性、阴性预测值、阳性预测值分别为81.8%、62.5%、89.1%、47.8%,具有良好的区分度、校准度。4.与7个LVO预测模型相比,新模型的敏感性最高、阴性预测值位列第二,特异性、阳性预测值与其他量表相当。5.采用新模型前瞻性对95例前循环AIS患者进行验证,结果表明,当新模型评分≥2分时,敏感性、特异性、阳性预测值、阴性预测值分别为85.0%、76.4%、72.9、89.4%,提示新模型可减少LVO患者漏诊率。结论1.新模型包含面瘫、凝视、失语、握力减退、风心病5项,每项为1分,总分5分,当评分≥2分时,对前循环LVO脑卒中预测效能高。2.新模型与7个预测模型相比敏感性和阴性预测值高,可降低前循环LVO患者漏诊率。3.通过前瞻性验证,证实了新模型对前循环LVO脑卒中以及优势半球、非优势半球LVO的预测价值,新模型能够简便、易行、快速识别前循环LVO脑卒中。更多还原

【Abstract】 Objective To construct a simple and accurate new scale for large vessel occlusion(LVO)prediction on the basis of comparison of stroke prediction performance in 7 domestic and foreign scales for large vessel occlusion(LVO),and then to prospectively verify the prediction performance of the new scale for LVO.Methods Patients with acute ischemic stroke(AIS)of anterior circulation were enrolled in Deyang People’s Hospital,and all enrolled were divided into LVO group and non-LVO group according to head vascular examinations.On the basis of comparing 7 prediction scales and reading literatures,35 predictors were selected.The difference of predictive factors was compared between patients with and without LVO,the independent risk factors of LVO were obtained by multivariate logistic regression analysis,and then a new LVO prediction scale was constructed.Receiver operator characteristic curve(ROC)was used to evaluate the predictive value of the new prediction scale,and the accuracy of the new prediction scale was compared with the other 7 scales.Ninety-five patients with AIS of anterior circulation were prospectively included to verify the predictive performance of the new prediction scale for LVO.Results 1.A total of 409 patients with AIS of anterior circulation were enrolled,of which 121 were LVO stroke and 288 were non-LVO stroke according to head vascular examinations.Multivariate logistic regression analysis found that facial paralysis,gaze,aphasia,weakened grip strength and rheumatic heart disease were independently associated with LVO.2.The above 5 predictors were assigned 1 and 0 points respectively according to whether they were positive or negative.The new LVO prediction scale was constructed,including facial paralysis,gaze,aphasia,weakened grip strength and rheumatic heart disease.3.The area under curve(AUC)of the new scale was 0.799,the cut-off value was 1.5,and the sensitivity,specificity,negative predictive value and positive predictive value were 81.8%,62.5%,89.1% and 47.8%,respectively,which had good discrimination and calibration.4.Compared with the other 7 LVO prediction scales,the new prediction scale had the highest sensitivity,the second highest negative predictive value,and the similar specificity and positive predictive value as other prediction scales.5.We prospectively validated 95 patients with AIS of anterior circulation using the new LVO prediction scale.The results showed that when the score of the new prediction scale was ≥2,the sensitivity,specificity,positive predictive value and negative predictive value were 85.0%,76.4%,72.9and 89.4%,respectively,suggesting that the new prediction scale could reduce the rate of missed diagnosis for LVO.Conclusion 1.The new LVO prediction scale included facial paralysis,gaze,aphasia,weakened grip strength and rheumatic heart disease,with a score of 1 for each item and a total score of 5.When the score was ≥2,the prediction efficiency of anterior circulation LVO stroke was high.2.Compared with the other 7 prediction scales,the new prediction scale has a higher sensitivity and negative predictive value,which can reduce the rate of missed diagnosis for patients of anterior circulation LVO.3.The predictive value of the new scale for anterior circulation LVO and LVO in dominant hemisphere and non-dominant hemisphere was confirmed through prospective verification.The new prediction scale can identify anterior circulation LVO stroke simply,easily and quickly.更多还原