Essen评分在TIA、缺血性小卒中与大卒中患者中预测效度的比较

摘要

目的：比较Essen卒中风险分层量表（Essen Stroke Risk Score，ESRS）预测短暂性脑缺血发作（transient ischemic attack，TIA）、缺血性小卒中和缺血性大卒中患者的卒中复发和联合血管事件发生的效度。方法以前瞻性、多中心中国国家卒中登记研究（China National Stroke Registry，CNSR）中连续录入的11384例完成1年随访的TIA、非心房颤动性缺血性卒中的住院患者为研究人群，小卒中定义为入院时缺血性卒中患者的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分≤3分，大卒中定义为NIHSS评分＞3分。采用曲线下面积（area under the curve，AUC）评价ESRS对TIA、缺血性小卒中和大卒中患者进行卒中复发和联合血管事件复发风险的分层能力，预测卒中复发和联合血管事件发生的效度。结果本研究有1061例TIA，3254例小卒中，7069例大卒中患者。在TIA患者中，ESRS预测卒中复发AUC=0.57，预测联合血管事件AUC=0.56；小卒中患者中，ESRS预测卒中复发的AUC=0.58，预测联合血管事件AUC=0.59；大卒中患者中，ESRS预测卒中复发的AUC=0.60，预测联合血管事件AUC=0.60。结论 ESRS评分对大卒中的卒中复发/联合血管事件发生的预测效度最高，其次是对小卒中，在TIA中预测效度最低，但是三组人群中差异无显著性。%Objective To prospectively compare the predictive accuracy of the Essen Stroke Risk Score (ESSR) in a large multicenter cohort of Chinese patients with TIA, ischemic minor stroke and major stroke. Methods The data of 11 384 admitted patients with acute ischemic stroke and transient ischemic attack (TIA) who were followed up 1 year was from a multicenter prospective cohort study covering 132 urban hospitals throughout China. Minor stroke was deifned as an National Institutes of Health Stroke Scale (NIHSS) score 3 at the time of ifrst assessment, major stroke was deifned as NIHSS score>3. We evaluated the predictive accuracy of ESRS of both recurrent stroke and combined vascular events in TIA, minor stroke and major stroke with area under the curve (AUC). Results In our study, 1061 cases were TIA patients, 3254 ones were minor stroke patients and 7069 ones were major stroke patients. The ESRS was modestly predictive with AUC=0.57 for recurrent stroke and AUC=0.56 for combined vascular events in TIA patients at 1 year; with AUC=0.58 for recurrent stroke and AUC=0.59 for combined vascular events in minor stroke patients; with AUC=0.60 for recurrent stroke and AUC=0.60 for combined vascular events in major stroke patients. Conclusion ESRS is equally able to predict the risk of recurrent stroke and combined vascular events in TIA, minor stroke and major stroke, although the predictive accuracy of the ESRS is highest in major stroke, second in minor stroke and lowest in TIA.