ESRS联合CISS分型对脑梗死复发的预测价值研究
发布时间：2018-10-18 12:03
【摘要】：目的:脑梗死(cerebral infarction,CI)是发病率、死亡率、残疾率和复发率都非常高的常见临床疾病。CI再发时会引起更严重的临床后果,患者可能丧失独立生活、工作能力,瘫痪卧床需要他人的持续照顾,严重者失去生命,这些都给患者及家属带来巨大的精神压力和经济负担。因此,如何预防脑梗死再发是神经科的一个研究重点,利用卒中复发风险预测工具识别卒中复发高危患者,对不同复发风险的患者进行分层治疗,既能降低高危患者的复发率又能实现医疗资源的有效合理配置。本研究评估Essen卒中风险评分量表(Essen Stroke Risk Score,ESRS)对脑梗死复发预测价值的可靠性,探讨联合应用ESRS及CISS分型对脑梗死复发的预测价值,筛选出更具准确性的预测模型。方法:收集自2015年6月1日至2016年1月31日共404名就诊于大连医科大学附属第一医院并收入院治疗的CI患者的临床病例资料,包括ESRS里各项:年龄、高血压(hypertension,HBP)、糖尿病(diabetes mellitus,DM)、既往心肌梗死(myocardial infarction,MI)、其他心脏病、周围血管疾病、吸烟、既往TIA或缺血性卒中病史以及性别、房颤病史(atrial fibrillation,AF)、ESRS评分,此外还包括患者的病因机制分型以及出院后1年内是否再发CI。根据CISS分型,将研究对象分为大动脉粥样硬化组、穿支动脉疾病组、心源性栓塞组、其他明确病因组和病因不明组。研究对象出院时均进行脑血管病(cerebrovascular disease,CVD)二级预防健康宣教,并根据患者脑梗死病因机制分型及其合并的CVD危险因素等具体情况进行个体化指导该患者的二级预防用药,患者出院1年时电话随访患者是否再发脑梗死。对所收集到的病例资料计数资料使用率(%)表示,组与组间的比较使用卡方检验进行分析;计量资料使用x±s,组与组比较使用t检验进行分析。计算ROC曲线下面积比较两种评分量表预测CI复发的效度,以AUC值表示。按a =0.05检验水准,以P0.05为差异有显著性。结果:本研究共404名患者符合纳入标准,其中35人失访,完成随访的患者共369人,随访率91.3%。研究对象出院1年时进行电话随访,复发脑梗死的患者归入复发组,无复发者归入未复发组,统计得出复发组共54人,未复发组共315人,计算得出总复发率为14.6%。整理所有患者的病例资料,比较完成随访患者和失访患者一般情况、危险因素、ESRS评分及CISS分型各方面差异,该差异无统计学意义。比较各病因组的复发率,由高到底依次为CS组(20%)、UE组(16.2%)、LAA组(14.5%)和PAD组(10.7%)。如表3所示,LAA的各机制组复发率由高到低依次为低灌注/栓子清除率下降(25%)、动脉到动脉栓塞(16.3%)、堵塞穿支口(10.99%)。根据ESRS评分对非心源性脑梗死患者进行分层,ESRS评分0-2分为低危组,3-9分为高危组,两组复发率分别为9.4%和17.6%,P=0.0330.05。绘制ESRS预测脑梗死复发的ROC曲线,AUC值为0.61。将CISS分型这一变量纳入ESRS成为改良ESRS,LAA型评2分,PAD型评1分。改良后再次根据评分进行风险分层,0-3分为低危组,4-11分为高危组,两组复发率分别为7.2%和15.6%。ESRS和改良ESRS预测CI复发的AUC值分别为0.57和0.577,差异无统计学意义。结论:1.ESRS对非心源性脑梗死有较好风险分层能力,并能有效预测复发风险。2.CISS分型各型间复发率存在差异,LAA型、CS型及UE型复发率较高,PAD型复发率最低。3.改良ESRS能对LAA型和PAD型患者的复发风险进行有效分层,对脑梗死复发的预测有一定价值,与ESRS相当,无统计学差异。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
，
本文编号：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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
，
本文编号：2279066
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