急性缺血性脑卒中早期预后不良的危险因素及洛桑急性卒中登记量表评分联合广泛性焦虑障碍量表评分的预测效能OA
Risk factors for early poor prognosis of acute ischemic stroke and the predictive efficacy of the Acute Stroke Registry and Analysis of Lausanne score combined with the Generalized Anxiety Disorder-7 score
目的 探讨急性缺血性脑卒中(AIS)患者早期预后的影响因素,并分析洛桑急性卒中登记量表(ASTRAL)联合广泛性焦虑障碍量表(GAD-7)对患者发病3个月预后的预测效能.方法 回顾性选取148例AIS患者作为研究对象,收集人口学资料、临床特征、实验室检查及影像学检查结果等临床资料.入院时采用ASTRAL评分评估卒中严重程度,采用GAD-7评分评估焦虑症状;发病3个月时采用改良Rankin量表(mRS)评估预后,将mRS评分≤2分者纳入预后良好组,mRS评分＞2分者纳入预后不良组.通过单因素和多因素Logistic回归分析筛选预后的影响因素;绘制受试者工作特征(ROC)曲线,评估ASTRAL评分、GAD-7评分及两者联合模型的预测效能.结果 148例患者中,预后良好102例(68.9％),预后不良46例(31.1％).多因素 Logistic 回归分析显示,年龄＞60 岁(OR=3.21,95％CI:1.35～7.64)、NIHSS 评分＞13 分(OR=4.85,95％CI:1.96～12.01)、合并糖尿病(OR=2.73,95％CI:1.18～6.32)、责任血管闭塞(OR=5.12,95％CI:2.13～12.31)和GAD-7评分≥10分(OR=3.67,95％CI:1.58～8.51)是AIS患者早期预后不良的独立危险因素(P＜0.05).ROC曲线分析显示,ASTRAL评分联合GAD-7评分预测预后不良的曲线下面积(AUC)为0.892(95％CI:0.835～0.949),显著高于ASTRAL 评分(AUC 为 0.815,95％CI:0.742～0.888)和 GAD-7 评分(AUC 为 0.736,95％CI:0.651～0.821)单独预测(Delong检验:Z=2.345,P=0.019;Z=3.672,P＜0.001),其灵敏度为 84.8％,特异度为 82.4％.结论 年龄＞60 岁、NIHSS评分＞13分、合并糖尿病、责任血管闭塞和GAD-7评分≥10分是AIS患者早期预后不良的独立危险因素;ASTRAL评分联合GAD-7评分对AIS患者早期预后具有较高的预测效能,可为临床制订个体化治疗和康复方案提供初步参考.
Objective To explore the influencing factors of early prognosis in patients with acute ischemic stroke(AIS)and analyze the predictive efficacy of the Acute Stroke Registry and Analysis of Lausanne(ASTRAL)score combined with the Generalized Anxiety Disorder-7(GAD-7)score for the 3-month prognosis after stroke onset.Methods A total of 148 AIS patients were retrospectively se-lected as the study subjects.Clinical data including demographic information,clinical characteristics,laboratory test results,and imaging findings were collected.At admission,the ASTRAL score was used to assess stroke severity,and the GAD-7 score was used to evaluate anxiety symptoms.At 3 months after stroke onset,the modified Rankin Scale(mRS)was used to assess prognosis.Patients with an mRS score ≤2 were included in good prognosis group,and those with an mRS score＞2 were in-cluded in poor prognosis group.Univariate and multivariate Logistic regression analyses were con-ducted to screen for prognostic influencing factors.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of the ASTRAL score,the GAD-7 score,and their combined model.Results Among the 148 patients,102(68.9％)had a good prognosis,and 46(31.1％)had a poor prognosis.Multivariate Logistic regression analysis showed that age＞60 years(OR=3.21,95％CI,1.35 to 7.64),National Institutes of Health Stroke Scale(NIHSS)score＞13(OR=4.85,95％CI,1.96 to 12.01),comorbid diabetes(OR=2.73,95％CI,1.18 to 6.32),responsible vessel occlusion(OR=5.12,95％CI,2.13 to 12.31),and GAD-7 score 10(OR=3.67,95％CI,1.58 to 8.51)were independent risk factors for early poor prognosis in AIS patients(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)for pre-dicting poor prognosis using the combined ASTRAL and GAD-7 scores was 0.892(95％CI,0.835 to 0.949),which was significantly higher than that of the ASTRAL score alone(AUC=0.815,95％CI,0.742 to 0.888)and the GAD-7 score alone(AUC=0.736,95％CI,0.651 to 0.821)(Delong test:Z=2.345,P=0.019;Z=3.672,P＜0.001).The sensitivity was 84.8％,and the specificity was 82.4％.Conclusion Age＞60 years,NIHSS score＞13,comorbid diabetes,responsible vessel occlusion,and GAD-7 score ≥10 are independent risk factors for early poor prog-nosis in AIS patients.The combined ASTRAL and GAD-7 scores have high predictive efficacy for the early prognosis of AIS patients and can provide a preliminary reference for the clinical formula-tion of individualized treatment and rehabilitation plans.
杜凤拖;李凤娥;王彩利;刘淑琴;李芳;张璐璐
山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000山西医科大学附属吕梁医院神经内科,山西吕梁,033000||吕梁市第一人民医院神经内科,山西吕梁,033000
医药卫生
急性缺血性脑卒中早期预后焦虑洛桑急性卒中登记量表广泛性焦虑障碍量表改良Rankin量表美国国立卫生研究院卒中量表糖尿病
acute ischemic strokeearly prognosisanxietyAcute Stroke Registry and Analy-sis of LausanneGeneralized Anxiety Disorder-7modified Rankin ScaleNational Institutes of Health Stroke Scalediabetes mellitus
《实用临床医药杂志》 2026 (7)
41-47,53,8
国家自然科学基金项目(821306521)
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