缺血性脑卒中的OCSP分型与NIHSS评分、临床神经功能缺损评分及预后之间相关性研究
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摘要
目的探讨缺血性脑卒中牛津郡社区卒中项目(Oxfordshire Community Stroke Project,OCSP)各亚型美国国立卫生研究院卒中量表(the National Institutes of Health Stroke Scale,NIHSS)评分、临床神经功能缺损评分(中国)间差异,各亚型的Barthel指数(Barthel index,BI)间是否存在差异,两种评分与Barthel指数间是否存在相关性,为正确选用脑卒中神经功能缺损评分量表评估病情及评价预后提供依据。方法前瞻性连续收集2008年11月至2009年12月宁夏医科大学附属医院神经内科收治的缺血性脑卒中病例资料,对符合纳入标准的586例患者入院时进行OCSP分型,并在入院当天进行NIHSS评分和临床神经功能缺损评分(中国),在发病90天时对患者进行随诊,统计死亡率,并以Barthel指数为标准,电话或门诊随访其个人日常生活活动能力(activities of daily living,ADL)。对OCSP分型、NIHSS评分和临床神经功能缺损评分(中国)间的差异作比较,并与Barthel指数做相关性分析。结果(1)缺血性脑卒中患者OCSP分型各亚型中,LACI患者所占比例最大,其次为PACI、TACI,比例最小的为POCI。OCSP各亚型患者在年龄和性别构成方面无显著性差异。根据患者入院时神经功能缺损进行的OCSP分型结果与MR诊断结果及发病24小时后的CT诊断结果比较,两者总的一致率为89.2%,其中TACI为90.5%,PACI为83.6%,POCI为82.5%,LACI为92.5%。说明缺血性脑卒中患者OCSP分型与影像学诊断结果有着良好的一致性。(2)缺血性脑卒中OCSP各亚型患者入院时的NIHSS评分比较,差异有统计学意义,其中OCSP分型中TACI入院时的NIHSS评分最高,表明其神经功能缺损程度最高,发病90天Barthel指数最低,发病90天死亡率最高,死亡率与其他各亚型比较差异有统计学意义(P<0.01),预后最差。LACI入院时NIHSS评分最低,表明其神经功能缺损程度最低,发病90天Barthel指数最高,发病90天死亡率为零,预后最好。(3)缺血性脑卒中患者OCSP各亚型入院时的临床神经功能缺损评分(中国)比较,差异有统计学意义,其中OCSP分型中TACI入院的临床神经功能缺损评分(中国)最高,表明其神经功能缺损程度最高,LACI入院时的临床神经功能缺损评分(中国)最低,表明其神经功能缺损程度最低。(4)缺血性脑卒中患者入院时NIHSS评分与临床神经功能缺损评分(中国)在存活组和死亡组之间差异有统计学意义,且死亡组的两种评分明显高于存活组。在缺血性脑卒中OCSP分型中各型入院时NIHSS评分和临床神经功能缺损评分(中国)的比较中,得出结果为:TACI、PACI亚型患者入院时的NIHSS评分与Barthel指数相关系数较高;POCI、LACI亚型患者入院时的临床神经功能缺损评分(中国)与Barthel指数相关系数较高。表明缺血性脑卒中患者OCSP分型中TACI、PACI最适合的量表是NIHSS评分; POCI、LACI最合适的量表是临床神经功能缺损评分(中国)。因此建议在不同分型中使用较合适的量表或者综合两个量表对病情及预后进行评估。结论对缺血性脑卒中患者在其发病早期进行正确的OCSP临床分型,不同亚型间选择NIHSS评分或临床神经功能缺损评分(中国)进行神经功能缺损评价,或将两种评分联合应用综合评价,在病情合理评估、个体化治疗、预测预后及正确的健康教育等方面有着重要的意义。
Objective To study the difference of NIHSS scale and the Chinese Clinical Neurological Defect scale among the ischemic stroke OCSP subtypes, whether there are the Barthel Index’s differences and correlations between the two scales, to choose suitable neurological defect clinical rating scales evaluating pathogenetic condition and measuring termination.
Mthods Prospective continuously collected all the case data of ischemic stroke patients admitted to the department of neurology of our hospital from 2008.11 ~2009.12, there were 586 patients coincided with the criteria, they were classified into Oxfordshire Community Stroke Project subtypes when in hospital, were tested with the National Institutes of Health Stroke Scale and the Chinese Clinical Neurological Defect scale respectively at admission, then calculated case fatality rate when they were followed up at 90 day after stroke and tested with the Barthel index at discharge to follow-up visit each activities of daily living by telephone or out-patient clinic. Compared NIHSS scale and the Chinese Clinical Neurological Defect scale of each OCSP subtype, and analysised their correlations with the Barthel index.
Results (1) Contrast the OCSP subtypes’constituent ratio of the ischemic stroke patients, the 1acunar infarct patients occupy the largest proportion, then the partial anterior circulation infarct patients, the total anterior circulation infarct patients, the smallest were the posterior circulation infarct patients. Each OCSP subtype were not significantly different between the ages and the genders. Compared the results of the patients’neurologic deficits on admission with that of the MR diagnosis and/or after 24 hours of CT, the total concordance rate was 89.2%, the concordance rate of TACI was 90.5%, PACI was 83.6%, POCI was 82.5%, LACI was 92.5%. It indicated the OCSP subtypes and the imaging diagnosis results had favourable coincidence.(2)Compare the NIHSS scores of each OCSP subtype when they were on admission, the differences have statistical significance, the NIHSS score of TACI is the highest, indicate the most serious neurologic deficit, the lowest Barthel Index and the highest case fatality rate at 90 day after stroke and compared with other subtypes has statistically significant differences(P<0.01), the worst prognosis. The NIHSS score of LACI is the lowest, indicate the mildest neurologic deficit, the highest Barthel Index and 0 case fatality rate at 90 day after stroke, the best prognosis. (3)Compare the Chinese Clinical Neurological Defect scale scores of each OCSP subtype when they were on admission, the differences have statistical significance, the Chinese Clinical Neurological Defect scale score of TACI is the highest, indicate the most serious neurologic deficit; the Chinese Clinical Neurological Defect scale score of LACI is the highest, indicate the mildest neurologic deficit.(4)The differences of the NIHSS scores and the Chinese Clinical Neurological Defect scale scores between survival and decease group in have statistical significance, and the two scores of the decease group are all significantly higher than the survival group. Compare each OCSP subtype of the NIHSS and the Chinese Clinical Neurological Defect scale, we can conclude: the coefficient correlation of the NIHSS and Barthel Index in TACI and PACI is higher than the Chinese Clinical Neurological Defect scale; the coefficient correlation of the Chinese Clinical Neurological Defect scale and Barthel Index in POCI and LACI is higher than the NIHSS. These indicate the more suitable measuring scale of TACI and PACI is the NIHSS; the more suitable measuring scale of POCI and LACI is the Chinese Clinical Neurological Defect scale. So when evaluating pathogenetic condition and measuring termination, we suggest choose the more suitable measuring scale or combine the two measuring scales.
Conclusions For the ischemic stroke patient, OCSP classification in the early onset, choose the more suitable measuring scale or combine the two measuring scales can be used to evaluate pathogenetic condition, guide the direct treatment, measure termination and right health education.
Objective To study the difference of NIHSS scale and the Chinese Clinical Neurological Defect scale among the ischemic stroke OCSP subtypes, whether there are the Barthel Index’s differences and correlations between the two scales, to choose suitable neurological defect clinical rating scales evaluating pathogenetic condition and measuring termination.
Mthods Prospective continuously collected all the case data of ischemic stroke patients admitted to the department of neurology of our hospital from 2008.11 ~2009.12, there were 586 patients coincided with the criteria, they were classified into Oxfordshire Community Stroke Project subtypes when in hospital, were tested with the National Institutes of Health Stroke Scale and the Chinese Clinical Neurological Defect scale respectively at admission, then calculated case fatality rate when they were followed up at 90 day after stroke and tested with the Barthel index at discharge to follow-up visit each activities of daily living by telephone or out-patient clinic. Compared NIHSS scale and the Chinese Clinical Neurological Defect scale of each OCSP subtype, and analysised their correlations with the Barthel index.
Results (1) Contrast the OCSP subtypes’constituent ratio of the ischemic stroke patients, the 1acunar infarct patients occupy the largest proportion, then the partial anterior circulation infarct patients, the total anterior circulation infarct patients, the smallest were the posterior circulation infarct patients. Each OCSP subtype were not significantly different between the ages and the genders. Compared the results of the patients’neurologic deficits on admission with that of the MR diagnosis and/or after 24 hours of CT, the total concordance rate was 89.2%, the concordance rate of TACI was 90.5%, PACI was 83.6%, POCI was 82.5%, LACI was 92.5%. It indicated the OCSP subtypes and the imaging diagnosis results had favourable coincidence.(2)Compare the NIHSS scores of each OCSP subtype when they were on admission, the differences have statistical significance, the NIHSS score of TACI is the highest, indicate the most serious neurologic deficit, the lowest Barthel Index and the highest case fatality rate at 90 day after stroke and compared with other subtypes has statistically significant differences(P<0.01), the worst prognosis. The NIHSS score of LACI is the lowest, indicate the mildest neurologic deficit, the highest Barthel Index and 0 case fatality rate at 90 day after stroke, the best prognosis. (3)Compare the Chinese Clinical Neurological Defect scale scores of each OCSP subtype when they were on admission, the differences have statistical significance, the Chinese Clinical Neurological Defect scale score of TACI is the highest, indicate the most serious neurologic deficit; the Chinese Clinical Neurological Defect scale score of LACI is the highest, indicate the mildest neurologic deficit.(4)The differences of the NIHSS scores and the Chinese Clinical Neurological Defect scale scores between survival and decease group in have statistical significance, and the two scores of the decease group are all significantly higher than the survival group. Compare each OCSP subtype of the NIHSS and the Chinese Clinical Neurological Defect scale, we can conclude: the coefficient correlation of the NIHSS and Barthel Index in TACI and PACI is higher than the Chinese Clinical Neurological Defect scale; the coefficient correlation of the Chinese Clinical Neurological Defect scale and Barthel Index in POCI and LACI is higher than the NIHSS. These indicate the more suitable measuring scale of TACI and PACI is the NIHSS; the more suitable measuring scale of POCI and LACI is the Chinese Clinical Neurological Defect scale. So when evaluating pathogenetic condition and measuring termination, we suggest choose the more suitable measuring scale or combine the two measuring scales.
Conclusions For the ischemic stroke patient, OCSP classification in the early onset, choose the more suitable measuring scale or combine the two measuring scales can be used to evaluate pathogenetic condition, guide the direct treatment, measure termination and right health education.
引文
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