ESRS 和 SPI-Ⅱ评分对急性缺血性脑卒中患者复发风险的评估作用

摘要

目的：探讨Essen卒中风险分层量表（Essen Stroke Risk Score，ESRS）和卒中预测工具-Ⅱ（Stroke Prognostic Instrument-Ⅱ，SPI-Ⅱ）对急性缺血性脑卒中（Acute Ischemic Stroke，AIS）1 y复发风险的评估作用。方法前瞻性的连续收集2012年12月～2016年6月北京大学航天临床医学院神经内科住院的AIS患者820例。详细记录入选患者的临床基线资料并完成ESRS及SPI-Ⅱ评分。于发病后1 y进行随访，以复发作为金标准，收集患者的复发情况等资料。通过描绘AIS患者ESRS和SPI-II的受试者工作特征曲线（ Receive Operating Characteristic curve，ROC），计算曲线下面积（ Area Under the Curve ，AUC）来比较2个量表预测作用。应用Hosmer-Lemeshow法评价预测模型和实际模型的拟合优度。结果符合纳入标准的患者共790例，失访30例（3．95％），最终纳入760例。随访1 y时，复发84例（11．05％）；死亡67例，死亡率（8．82％）。2个量表ROC曲线下面积AUC值分别为0．576（P＜0．05，95％CI：0．540～0．611）、0．583（P＜0．05，95％CI：0．547～0．618），2个量表AUC值差异无统计学意义（P＞0．05）；Hosmer-Lemeshow法检验，χ2值分别为3．391、5．797（均P＞0．05）表明预测模型与实际模型拟合良好。结论 ESRS和SPI-II评分对AIS患者1 y复发评估作用基本一致。%Objective In this study ,we investigated the prognostic value of ESRS and SPI-Ⅱin patients with acute ischemic stroke ( AIS) .Methods In this prospective cohort study ,baseline data were collected from the patients who were hospitalized in the Neurology Department of Aerospace Central Hospital between December 2012 and June 2016 and fol-lowed-up for one year.ESRS and SPI-Ⅱscore were calculated from both patients and controls .After one year follow-up, clinical outcomes were collected from patients or their family members .The patients that had recurrence were cases while the rest without recurrence were served as control .ROC curves were determined for the ESRS and SPI-Ⅱrespectively and compared using MedCalc.Results A total of 760 patients with AIS finished the follow-up,in which showed 84(11.05%) recurrence,67(8.82%) deaths.The ESRS demonstrated adequate calibration and good discrimination in the patients with AIS (area under the ROC curve[AUC]=0.576(P<0.05,95%CI:0.540~0.611).This was comparable to the SPI-Ⅱ:[AUC]=0.583(P<0.05,95%CI:0.547~0.618).The two scoring systems did not show significant difference (P>0. 05).χ2 of Hosmer-Lemeshow were 3.391,5.797(P>0.05).Conclusion ESRS and SPI-Ⅱare equally able to stratify the recurrence risk of AIS in Chinese patients .