【摘要】 目的　评价脑血管血液动力学检测预警卒中的真实性和可靠性指标及最佳截断点。方法　以整群抽样的方法抽取东北等地区 35岁及以上的人群 2 0 333例 ,在脑血管病危险因素基线调查时全部接受脑血管血液动力学检测 ,并对诸指标的检测结果进行总积分。检测随访目标人群卒中发病 ,随访 4年共发生确诊卒中患者 16 8例 ,以随访中临床卒中发生为金标准 ,用筛检试验方法评价脑血管血液动力学检测积分的预警效能及最佳截断点。结果　经过绘制受试者工作特征 (ROC)曲线 ,血液动力学检测预警卒中的最佳积分值截断点应为 75分以下。以 75分为截断点 ,脑血液动力学检测后 4年内预警卒中的敏感度、特异度、准确度、阳性预告值、阴性预告值、阳性似然比、阴性似然比和Youden指数分别为 87.5 0 %、6 7.70 %、6 7.86 %、2 .2 1%、99.85 %、2 .71、0 .18和 0 .5 5 ,其中预警脑血栓的敏感度和阳性预告值高于预警脑出血 ,在具有危险因素暴露的卒中高危人群中 ,阳性预告值是普通人群的 2～ 3倍。脑血管血液动力学临床检测积分值的变异系数为 4 .0 3% ,两名医师临床检测积分值判定的符合率为 97.6 2 % ,Kappa值为0 .94。结论　血液动力学检测对卒中具有良好的预警效果 ,其中脑血栓的预警效果优于脑出血。最佳分值截断点为 75分?更多还原

【Abstract】 Objective To evaluate efficacy and optimal cut off point through cerebral vascular hemodynamic indexes (CVHI) examination to predict stroke. Methods A number of 20 333 people at 35 years old and over were checked by CVHI and accumulative score was calculated according to the value of detected indexes. Risk factors of stroke were investigated simultaneously. One hundred and sixty eight patients with stroke occurred during 4 year following up. Typical syndromes and signs stroke were used as golden standard to evaluate screening efficacy of CVHI. Results Score of optimal cut off point of cerebral vascular hemodynamic indexes was under 75 in ROC curve analyses. Sensitivity, specificity, accuracy, positive and negative predictive values, positive and negative likelihood ratios as well as Youden’s index for predicting stroke within 4 years after examination were found to be 87.50 %, 67.70 %, 67.86 %, 2.21 %, 99.85 %, 2.71 , 0.18 and 0.55 respectively. Sensitivity and positive predict values for predicting cerebral vascular thrombosis were superior to predicting cerebral hemorrhage. Positive predicting value in risk exposure population was higher than that of overall population. Coefficiency of variation of cerebral vascular hemodynamic examination was 4.03 %. The agreement rate of examination between two physicians was 97.62 % and Kappa value was 0.94 . Conclusion The score of optimal cut off point of cerebral vascular hemodynamic indexes examination was 75. Both Efficacy and reliability for predicting stroke seemed to be good, especially for predicting cerebral vascular thrombosis.更多还原