后循环侧支评分联合D-二聚体对后循环急性缺血性脑卒中患者血管内治疗预后的预测价值OA
Predictive value of posterior circulation collateral score combined with D-dimer for prognosis of patients with posterior circulation acute ischemic stroke undergoing endovascular treatment
目的 探讨后循环侧支评分(posterior circulation collateral score,PC-CS)联合D-二聚体对后循环急性缺血性脑卒中(acute ischemic stroke,AIS)患者血管内治疗预后的预测价值.方法 回顾性分析接受血管内治疗的139例后循环AIS患者,依据治疗后90 d改良Rankin量表评分分为预后良好组(n=71)与预后不良组(n=68).比较两组患者一般资料的差异,采用Logistic回归分析获得影响预后的危险因素,应用ROC曲线分析PC-CS联合D-二聚体对后循环AIS患者预后的预测效能.结果 预后不良组年龄、基线美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、D-二聚体水平明显高于预后良好组,PC-CS明显低于预后良好组,差异均有统计学意义(均P＜0.001).Logistic回归分析结果显示,年龄大、基线NIHSS评分高、PC-CS低、D-二聚体水平高为后循环AIS患者血管内治疗预后不良的危险因素(均P＜0.001).ROC曲线分析结果显示,PC-CS、D-二聚体单项指标及二者联合预测后循环AIS患者血管内治疗预后不良的AUC值分别为0.812、0.938、0.975;联合预测模型的AUC值显著高于PC-CS、D-二聚体单一指标,提示联合预测的判别效能更优.采用Bootstrap法重复抽样500次对模型进行内部验证,C-index为0.870,表明模型具有良好的区分度;校准曲线结果显示,模型预测概率与实际观测概率拟合度较好,提示模型具有理想的校准一致性.结论 PC-CS联合D-二聚体对后循环AIS血管内治疗患者预后具有较高的预测价值.
Objective To investigate the predictive value of posterior circulation collateral score(PC-CS)combined with D-dimer for the prognosis of patients with posterior circulation acute ischemic stroke(AIS)undergoing endovascular treatment.Methods A retrospective analysis was conducted on 139 patients with posterior circulation AIS who had received endovascular treatment.Based on the 90-day modified Rankin scale score,these patients were divided into a good prognosis group(n=71)and a poor prognosis group(n=68).Differences in baseline characteristics between the two groups were compared.Logistic regression analysis was used to identify risk factors affecting the prognosis.ROC curves were plotted to evaluate the predictive performance of PC-CS combined with D-dimer for the prognosis in patients with posterior circulation AIS.Results The poor prognosis group had significantly older age,higher baseline National Institutes of Health stroke scale(NIHSS)score and D-dimer level,and significantly lower PC-CS compared with the good prognosis group(all P＜0.001).Logistic regression analysis showed that older age,higher baseline NIHSS score,lower PC-CS,and higher D-dimer level were risk factors for poor prognosis in patients with posterior circulation AIS undergoing endovascular treatment(all P＜0.001).ROC curve analysis showed that the AUC value for PC-CS,D-dimer,and their combination in predicting poor prognosis of patients with posterior circulation AIS undergoing endovascular treatment was 0.812,0.938 and 0.975,respectively.The combined prediction model had a significantly higher AUC value than either single indicator,indicating better discriminant efficacy.Internal validation was performed using Bootstrap resampling for 500 times,yielding a C-index of 0.870,indicating good discrimination.The calibration curve showed good agreement between model-predicted probabilities and actual observed probabilities,suggesting ideal calibration consistency.Conclusion The combination of PC-CS and D-dimer has high predictive value for the prognosis of patients with posterior circulation AIS undergoing endovascular treatment.
陈惠云;李世超;刘春林;蒋菲菲;冯康康;谢悦;徐祥辉
453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科453000 河南新乡,新乡市第一人民医院神经内科
医药卫生
后循环急性缺血性脑卒中血管内治疗侧支循环D-二聚体预后
posterior circulation acute ischemic strokesendovascular treatmentcollateral circulationD-dimerprognosis
《实用心电与临床诊疗》 2026 (3)
461-465,5
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