ESRS聯合CISS分型對腦梗死復發(fā)的預測價值研究
發(fā)布時間：2018-10-18 12:03
【摘要】：目的:腦梗死(cerebral infarction,CI)是發(fā)病率、死亡率、殘疾率和復發(fā)率都非常高的常見臨床疾病。CI再發(fā)時會引起更嚴重的臨床后果,患者可能喪失獨立生活、工作能力,癱瘓臥床需要他人的持續(xù)照顧,嚴重者失去生命,這些都給患者及家屬帶來巨大的精神壓力和經濟負擔。因此,如何預防腦梗死再發(fā)是神經科的一個研究重點,利用卒中復發(fā)風險預測工具識別卒中復發(fā)高�；颊�,對不同復發(fā)風險的患者進行分層治療,既能降低高�；颊叩膹桶l(fā)率又能實現醫(yī)療資源的有效合理配置。本研究評估Essen卒中風險評分量表(Essen Stroke Risk Score,ESRS)對腦梗死復發(fā)預測價值的可靠性,探討聯合應用ESRS及CISS分型對腦梗死復發(fā)的預測價值,篩選出更具準確性的預測模型。方法:收集自2015年6月1日至2016年1月31日共404名就診于大連醫(yī)科大學附屬第一醫(yī)院并收入院治療的CI患者的臨床病例資料,包括ESRS里各項:年齡、高血壓(hypertension,HBP)、糖尿病(diabetes mellitus,DM)、既往心肌梗死(myocardial infarction,MI)、其他心臟病、周圍血管疾病、吸煙、既往TIA或缺血性卒中病史以及性別、房顫病史(atrial fibrillation,AF)、ESRS評分,此外還包括患者的病因機制分型以及出院后1年內是否再發(fā)CI。根據CISS分型,將研究對象分為大動脈粥樣硬化組、穿支動脈疾病組、心源性栓塞組、其他明確病因組和病因不明組。研究對象出院時均進行腦血管病(cerebrovascular disease,CVD)二級預防健康宣教,并根據患者腦梗死病因機制分型及其合并的CVD危險因素等具體情況進行個體化指導該患者的二級預防用藥,患者出院1年時電話隨訪患者是否再發(fā)腦梗死。對所收集到的病例資料計數資料使用率(%)表示,組與組間的比較使用卡方檢驗進行分析;計量資料使用x±s,組與組比較使用t檢驗進行分析。計算ROC曲線下面積比較兩種評分量表預測CI復發(fā)的效度,以AUC值表示。按a =0.05檢驗水準,以P0.05為差異有顯著性。結果:本研究共404名患者符合納入標準,其中35人失訪,完成隨訪的患者共369人,隨訪率91.3%。研究對象出院1年時進行電話隨訪,復發(fā)腦梗死的患者歸入復發(fā)組,無復發(fā)者歸入未復發(fā)組,統計得出復發(fā)組共54人,未復發(fā)組共315人,計算得出總復發(fā)率為14.6%。整理所有患者的病例資料,比較完成隨訪患者和失訪患者一般情況、危險因素、ESRS評分及CISS分型各方面差異,該差異無統計學意義。比較各病因組的復發(fā)率,由高到底依次為CS組(20%)、UE組(16.2%)、LAA組(14.5%)和PAD組(10.7%)。如表3所示,LAA的各機制組復發(fā)率由高到低依次為低灌注/栓子清除率下降(25%)、動脈到動脈栓塞(16.3%)、堵塞穿支口(10.99%)。根據ESRS評分對非心源性腦梗死患者進行分層,ESRS評分0-2分為低危組,3-9分為高危組,兩組復發(fā)率分別為9.4%和17.6%,P=0.0330.05。繪制ESRS預測腦梗死復發(fā)的ROC曲線,AUC值為0.61。將CISS分型這一變量納入ESRS成為改良ESRS,LAA型評2分,PAD型評1分。改良后再次根據評分進行風險分層,0-3分為低危組,4-11分為高危組,兩組復發(fā)率分別為7.2%和15.6%。ESRS和改良ESRS預測CI復發(fā)的AUC值分別為0.57和0.577,差異無統計學意義。結論:1.ESRS對非心源性腦梗死有較好風險分層能力,并能有效預測復發(fā)風險。2.CISS分型各型間復發(fā)率存在差異,LAA型、CS型及UE型復發(fā)率較高,PAD型復發(fā)率最低。3.改良ESRS能對LAA型和PAD型患者的復發(fā)風險進行有效分層,對腦梗死復發(fā)的預測有一定價值,與ESRS相當,無統計學差異。
[Abstract]:Objective: Cerebral infarction (CI) is a common clinical disease with high morbidity, mortality, disability rate and recurrence rate. The CI regenerates more serious clinical consequences, the patient may lose its own life, the ability to work, the paralysis lying in bed requires the continuous care of others, and the serious person loses life, which brings great mental pressure and economic burden to the patient and the family. Therefore, how to prevent cerebral infarction is a key research focus in neurology, and the risk prediction tool for stroke recurrence is used to identify patients with high risk of stroke relapse, and the patients with different relapse risk are treated with layered therapy. not only can reduce the recurrence rate of the high-risk patients, but also can realize the effective allocation of medical resources. This study evaluated the reliability of Essen Stroke Risk Score (ESRS) in predicting the recurrence of cerebral infarction, and explored the predictive value of ESRS and CISS classification in predicting the recurrence of cerebral infarction, and screened a more accurate prediction model. Methods: The clinical data of 404 patients with CI, including age, hypertension (HBP) and diabetes mellitus (DM), were collected from June 1, 2015 to January 31, 2016 at the First Affiliated Hospital of Dalian Medical University. Previous myocardial infarction (MI), other heart disease, peripheral vascular disease, smoking, past history of TIA or ischemic stroke, and gender, history of atrial fibrillation (AF), ESRS scores, and also patient's cause mechanism classification and whether the CI was reissued within 1 year after discharge. According to CISS classification, the subjects were divided into aortic atherosclerosis group, coronary artery disease group, cardiogenic embolism group, other definite cause group and unknown etiology group. Objective To study the secondary prevention and treatment of cerebral vascular disease (CVD) in patients with cerebral vascular disease (CVD) and to individually guide the secondary prevention of the patients according to the mechanism of cerebral infarction and the risk factors of CVD in patients with cerebral infarction. At 1 year of discharge, the patient was followed up for further cerebral infarction. The collected case data count data usage rate (%) indicates that the comparison between the group and the group is analyzed using the card square test; the measurement data is analyzed using the t-test for the group comparison with the group comparison. The effect degree of CI recurrence was predicted by comparing two scoring scales under the ROC curve, and the AUC values were expressed. The level was examined by a = 0.05, and the difference was significant with P0.05. Results: A total of 404 patients were enrolled in this study, of whom 35 were lost to follow-up and 369 patients were followed up with a follow-up rate of 91.3%. The study subjects were followed up for 1 year. The patients with recurrent cerebral infarction were classified as recurrence group and no recurrence was included in the non-recurrent group. There were 54 patients in the relapse group and 315 in the non-recurrence group. The total recurrence rate was 14. 6%. There was no statistically significant difference in general conditions, risk factors, ESRS scores, and CISS types in patients with follow-up and loss to follow-up compared with case data for all patients. The recurrence rate was higher in CS group (20%), UE group (16. 2%), LAA group (14.5%) and PAD group (10.7%). As shown in Table 3, the recurrence rate of LAA was reduced from high to low in turn at low perfusion/ emboli clearance (25%), artery to arterial embolization (16. 3%), and blocking through the branch (10. 99%). Patients with non-cardiac infarction were stratified according to ESRS score, ESRS score 0-2 was divided into low-risk group, 3-9 were classified into high-risk group, and the recurrence rates were 94.4% and 17. 6%, respectively, P = 0.0330. 05. The ROC curve of recurrence of cerebral infarction was predicted by ESRS, and the AUC value was 0. 61. This variable of CISS type was included in ESRS as modified ESRS, LA Atype evaluation score 2 and PAD type evaluation 1 point. After improvement, risk stratification was performed again according to the score, 0-3 was divided into low-risk group, 4-11 were classified into high-risk group, and the recurrence rates were 74.2% and 15.6%, respectively. The AUC values of ESRS and modified ESRS predicted CI recurrence were 0. 57 and 0. 577, respectively. There was no statistical significance in the difference. Conclusion: 1. ESRS has better risk stratification ability for non-cardiac infarction, and can predict recurrence risk effectively. The improved ESRS can effectively stratify the recurrence risk of LA Atype and PAD type patients, and has a certain value for the prognosis of cerebral infarction recurrence, and has no statistical difference compared with ESRS.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
，
本文編號：2279066
[Abstract]:Objective: Cerebral infarction (CI) is a common clinical disease with high morbidity, mortality, disability rate and recurrence rate. The CI regenerates more serious clinical consequences, the patient may lose its own life, the ability to work, the paralysis lying in bed requires the continuous care of others, and the serious person loses life, which brings great mental pressure and economic burden to the patient and the family. Therefore, how to prevent cerebral infarction is a key research focus in neurology, and the risk prediction tool for stroke recurrence is used to identify patients with high risk of stroke relapse, and the patients with different relapse risk are treated with layered therapy. not only can reduce the recurrence rate of the high-risk patients, but also can realize the effective allocation of medical resources. This study evaluated the reliability of Essen Stroke Risk Score (ESRS) in predicting the recurrence of cerebral infarction, and explored the predictive value of ESRS and CISS classification in predicting the recurrence of cerebral infarction, and screened a more accurate prediction model. Methods: The clinical data of 404 patients with CI, including age, hypertension (HBP) and diabetes mellitus (DM), were collected from June 1, 2015 to January 31, 2016 at the First Affiliated Hospital of Dalian Medical University. Previous myocardial infarction (MI), other heart disease, peripheral vascular disease, smoking, past history of TIA or ischemic stroke, and gender, history of atrial fibrillation (AF), ESRS scores, and also patient's cause mechanism classification and whether the CI was reissued within 1 year after discharge. According to CISS classification, the subjects were divided into aortic atherosclerosis group, coronary artery disease group, cardiogenic embolism group, other definite cause group and unknown etiology group. Objective To study the secondary prevention and treatment of cerebral vascular disease (CVD) in patients with cerebral vascular disease (CVD) and to individually guide the secondary prevention of the patients according to the mechanism of cerebral infarction and the risk factors of CVD in patients with cerebral infarction. At 1 year of discharge, the patient was followed up for further cerebral infarction. The collected case data count data usage rate (%) indicates that the comparison between the group and the group is analyzed using the card square test; the measurement data is analyzed using the t-test for the group comparison with the group comparison. The effect degree of CI recurrence was predicted by comparing two scoring scales under the ROC curve, and the AUC values were expressed. The level was examined by a = 0.05, and the difference was significant with P0.05. Results: A total of 404 patients were enrolled in this study, of whom 35 were lost to follow-up and 369 patients were followed up with a follow-up rate of 91.3%. The study subjects were followed up for 1 year. The patients with recurrent cerebral infarction were classified as recurrence group and no recurrence was included in the non-recurrent group. There were 54 patients in the relapse group and 315 in the non-recurrence group. The total recurrence rate was 14. 6%. There was no statistically significant difference in general conditions, risk factors, ESRS scores, and CISS types in patients with follow-up and loss to follow-up compared with case data for all patients. The recurrence rate was higher in CS group (20%), UE group (16. 2%), LAA group (14.5%) and PAD group (10.7%). As shown in Table 3, the recurrence rate of LAA was reduced from high to low in turn at low perfusion/ emboli clearance (25%), artery to arterial embolization (16. 3%), and blocking through the branch (10. 99%). Patients with non-cardiac infarction were stratified according to ESRS score, ESRS score 0-2 was divided into low-risk group, 3-9 were classified into high-risk group, and the recurrence rates were 94.4% and 17. 6%, respectively, P = 0.0330. 05. The ROC curve of recurrence of cerebral infarction was predicted by ESRS, and the AUC value was 0. 61. This variable of CISS type was included in ESRS as modified ESRS, LA Atype evaluation score 2 and PAD type evaluation 1 point. After improvement, risk stratification was performed again according to the score, 0-3 was divided into low-risk group, 4-11 were classified into high-risk group, and the recurrence rates were 74.2% and 15.6%, respectively. The AUC values of ESRS and modified ESRS predicted CI recurrence were 0. 57 and 0. 577, respectively. There was no statistical significance in the difference. Conclusion: 1. ESRS has better risk stratification ability for non-cardiac infarction, and can predict recurrence risk effectively. The improved ESRS can effectively stratify the recurrence risk of LA Atype and PAD type patients, and has a certain value for the prognosis of cerebral infarction recurrence, and has no statistical difference compared with ESRS.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
，
本文編號：2279066
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