摘要
目的探讨眩晕评分、短暂性脑缺血发作评分(ABCD2)评分与急性脑梗死(ACI)患者脑血流动力学的相关性及其预后预测价值。方法采取回顾性研究,选择2022年12月—2023年12月已完成3个月随访的104例ACI患者作为研究对象。根据患者预后情况进行分组,将改良Rankin量表(mRS)评分≥3分的34例ACI患者纳入预后不良组,将mRS评分<3分的70例ACI患者纳入预后良好组。统计治疗前、治疗2周时ACI患者眩晕评分、ABCD2评分及脑血流动力学指标[平均血流速度(V_(mean)),平均脑血流量(Q_(mean)),血管特性阻抗(Z_(c)),脑血管周围阻力(R_(v))]差异;采用双变量相关性Pearson分析眩晕评分、ABCD2评分与ACI患者脑血流动力学的关系;统计随访3个月时两组患者基线资料;采用二元Logistic回归分析眩晕评分、ABCD2评分与ACI患者预后的关系;采用受试者工作特征(ROC)曲线评估眩晕评分、ABCD2评分预测ACI患者预后的价值。结果治疗2周时,ACI患者眩晕评分、ABCD2、Z_(c)、R_(v)均低于治疗前,V_(mean)、Q_(mean)均高于治疗前(均P<0.05);相关性分析显示,眩晕评分、ABCD2评分与V_(mean)、Q_(mean)呈负相关(r_(眩晕评分)=-0.468、-0.595,r_(ABCD2评分)=-0.559、-0.500,均P<0.001),与Z_(c)、R_(v)呈正相关(r_(眩晕评分)=0.480、0.610,r_(ABCD2评分)=0.354、0.578,均P<0.001)。随访3个月时,ACI患者预后不良组美国国立卫生研究院卒中量表(NIHSS)评分、眩晕、ABCD2评分、Z_(c)、R_(v)高于预后良好组,V_(mean)、Q_(mean)低于预后良好组(P<0.05);二元Logistic回归分析结果显示,NIHSS评分、眩晕及ABCD2评分高和Z_(c)、R_(v)高水平是ACI患者预后不良的危险因素(OR=3.033、1.485、2.397、1.482、1.035,均P<0.05),V_(mean)、Q_(mean)高水平是保护因素(OR=0.193、0.218,P<0.05);ROC曲线显示,NIHSS评分、眩晕、ABCD2评分,V_(mean)、Q_(mean)、Z_(c)、R_(v)联合预测ACI患者预后不良的曲线下面积(AUC)为0.981,高于单一指标的诊断效能。结论眩晕评分、ABCD2评分与ACI患者脑血流动力学密切相关,能够有效预测患者预后不良风险。
Objective To investigate the correlation between vertigo score,transient ischemic attack(ABCD2)score,cerebral hemodynamics,and their prognostic value in patients with acute cerebral infarction(ACI).Methods This retrospective study included 104 ACI patients with 3-month follow-up(December 2022 to December 2023).Patients were divided into poor prognosis group(mRS score≥3,n=34)and good prognosis group(mRS score<3,n=70).Vertigo score,ABCD2 score,and cerebral hemodynamic indexes[mean blood flow velocity(V_(mean)),mean cerebral blood flow(Q_(mean)),vascular characteristic impedance(Zc),cerebral vascular peripheral resistance(Rv)]were assessed before treatment and 2 weeks post-treatment.Pearson correlation analysis was used to assess the relationship between vertigo score,ABCD2 score and cerebral hemodynamics in ACI patients.Baseline data of the two groups were collected and analyzed at 3-month follow-up.Binary Logistic regression analysis was used to analyze the factors affecting the prognosis of ACI patients.Receiver operating characteristic(ROC)curve was used to evaluate predictive value of vertigo and ABCD2 scores for prognosis in ACI patients.Results After 2 weeks of treatment,the vertigo score,ABCD2,Z_(c) and R_(v) of ACI patients were lower than those before treatment,and V_(mean) and Q_(mean) were higher than those before treatment(all P<0.05).Correlation analysis showed that vertigo score and ABCD2 score were negatively correlated with V_(mean) and Q_(mean)(r_(vertigo score)=-0.468,-0.595,r_(ABCD2 score)=-0.559,-0.500,all P<0.001),and positively correlated with Z_(c) and Rv(r_(vertigo score)=0.480,0.610,r_(ABCD2 score)=0.354,0.578,all P<0.001).At 3-month follow-up,the scores of NIHSS,vertigo,and ABCD2,as well as Z_(c) and R_(v) in the poor prognosis group were higher than those in the good prognosis group,while V_(mean) and Q_(mean) were lower than those in the good prognosis group(all P<0.05).Binary logistic regression analysis showed that high NIHSS,vertigo and ABCD2 scores,high levels of Z_(c) and R_(v) were risk factors for poor prognosis(OR=3.033,1.485,2.397,1.482,1.035,all P<0.05)and high levels of V_(mean) and Q_(mean) were protective factors(OR=0.193,0.218,both P<0.05)in ACI patients.ROC curve showed that the area under the curve(AUC)of NIHSS,vertigo,ABCD2 score,V_(mean),Q_(mean),Z_(c) and R_(v) in predicting the poor prognosis of ACI patients was 0.981,which was higher than the diagnostic efficiency of single index.Conclusion Vertigo score and ABCD2 score are effective predictors of cerebral hemodynamics dysfunction and poor prognosis in ACI patients,providing insights for clinical decision-making.
作者
刘科位
胡俊秋
王玉梅
蒋力
赵江
陶涛
LIU Kewei;HU Junqiu;WANG Yumei;JIANG Li;ZHAO Jiang;TAO Tao(Department of Neurology,Rongxian People's Hospital,Zigong Sichuan 643100,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第9期1179-1183,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
四川省教育厅自然科学基金(15ZA0168)。
关键词
急性脑梗死
眩晕
短暂性脑缺血发作
脑血流动力学
ABCD2评分
预后
Acute cerebral infarction
Vertigo
Transient cerebral ischemic attaok
Cerebral hemodynamics
ABCD2 score
Prognosis
