摘要
目的探讨急性缺血性卒中超早期美国国立卫生研究院脑卒中量表(NIHSS)评分与CT脑血管成像(CTA)对脑血管闭塞病变的预测价值。方法对93例急性缺血性脑卒中患者在发病6h内进行NIHSS评分,根据NIHSS评分分为NIHSS评分≤6分组、NIHSS7～14分组、NIHSS≥15分组。同时进行CTA检查。分析NIHSS评分与CTA显示血管病变的关系。结果 93例急性缺血性脑卒中患者NIHSS评分平均为9.57±5.10分。CTA显示脑动脉正常32例(34.41%),脑动脉狭窄23例(24.73%),脑动脉闭塞38例(40.86%)。CTA显示有脑动脉狭窄或闭塞患者的NIHSS评分(10.53±5.43)高于无脑动脉病变的患者评分(8.13±4.23,P<0.01),其中脑动脉闭塞患者NIHSS评分(12.14±4.99)明显高于无脑动脉病变患者评分(P<0.001)。NIHSS评分≤6分组的16例患者中CTA显示脑动脉狭窄4例(25%),脑动脉闭塞3例(18.75%);NIHSS评分为7～14分组共66例,脑动脉狭窄和动脉闭塞比例分别为24.24%(16/66)和43.94%(29/66);NIHSS评分15分以上组患者脑动脉狭窄和动脉闭塞的比例分别为27.27%(2/11)和54.55%(6/11)。NIHSS评分≥15者在CTA上显示血管狭窄或闭塞的阳性率达95%,根据NIHSS评分预测CTA上显示的血管闭塞的阳性预测值为84.3%。经Logistic回归分析,发病时NIHSS评分与CTA检出血管闭塞相关(r=0.22,P<0.05),超急性期NIHSS评分为预测CTA显示血管闭塞的独立因素(OR=1.1,95%CI=0.6～1.65,P<0.001)。结论急性缺血性脑卒中超早期HIHSS评分与CTA显示脑动脉闭塞相关,急性缺血性卒中的神经功能缺损程度较重往往提示CTA上存在大血管狭窄或闭塞的可能。
Objective To investigate the value of National Institutes of Health Stroke Scale （NIHSS） score in predicting large vessel occlusion in acute ischemic stroke. Methods Ninety-three acute ischemic stroke patients who received intracranial CT angiography （CTA） within 6 hours of symptom onset were prospectively studied. All patients were divided into 3 groups according to NIHSS scores. Stroke severity on admission was determined using the National Institute of Health Stroke Scale （NIHSS）. Results The mean admission NIHSS score of 93 patients was 9.57±5.10. An arterial occlusion was detected in 38 patients, arterial stenosis was found in 23 and normal arterial was in 32 patients. The baseline NIHSS score was significantly higher in the group of patients with arterial stenosis or occlusion than that of no arterial occlusion group（12.14±4.99 vs 8.13±4.23, P0.001）. Four of 16 patients （18.75%） with NIHSS score of 1-5 had visible arterial occlusion, 29 patients （43.94%） with NIHSS score of 7-14 and 6 patients （54.55%） with NIHSS score above 15 had an arterial occlusion. A direct relation between the baseline NIHSS score and the likelihood of the presence of an occlusion on CTA is demonstrated（r=0.22,P0.05）. Nighty-five percent patients with an NIHSS score of ≥15 showed an occlusion on CTA and PPV to find arterial stenosis or occlusion was 84.3%. NIHSS was a predictor for large arterial occlusion （OR=1.1, 95%=CI 0.6-1.65, P0.001）in a logistic regression analysis. Conclusion There is a significant association of admission NIHSS scores and the presence of a large-vessel occlusion. Severe neurologic dysfunction in acute ischemic strokemay indict the evidence of large-vessel occlusion on CTA.
出处
《脑与神经疾病杂志》
2010年第6期408-412,共5页
Journal of Brain and Nervous Diseases
基金
国家科技攻关计划项目(2004BA714B06-1)
