CAJ | 학술논문

目的探讨格拉斯哥昏迷评分 (Glasgow Coma Scale,GCS) 及美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS) 对基底动脉尖综合征(top of the basilar syndrome,TOBS)转归的预测价值.方法从南京卒中注册系统中筛选出符合基底动脉尖综合征诊断的64例患者,根据卒中后30 d改良Rankin量表评分(modified Rankin Scale,mRS)分为好转组(0～3分)和不良转归组(4～6分),对两组入院时GCS、NIHSS评分进行回顾性分析.结果不良转归组中GCS分值低于好转组(P<0.01);NIHSS分值均高于好转组(P=0.011).经Logistic回归校正年龄、性别及治疗方式3个因素后,GCS评分OR值0.301(95% CI 0.167～0.542);NIHSS评分OR值1.436(95% CI 1.147～1.796), 二者均为独立预测因素.ROC曲线分析显示,以GCS分值10分作为预测TOBS预后的界点,其灵敏度87.9%,特异度83.9%;以NIHSS分值14分作为界点,灵敏度63.6%,特异度77.4%.结论 GCS、NIHSS均是基底动脉尖综合征转归重要的预测指标;GCS≤10分、NIHSS≥14分对于基底动脉尖综合征患者不良转归均有重要的预测价值,GCS预测效价高于NIHSS.
목적 탐토격랍사가혼미평분 (Glasgow Coma Scale,GCS) 급미국국립위생원신경공능결손평분(National Institutes of Health Stroke Scale,NIHSS) 대기저동맥첨종합정(top of the basilar syndrome,TOBS)전귀적예측개치.방법 종남경졸중주책계통중사선출부합기저동맥첨종합정진단적64례환자,근거졸중후30 d개량Rankin량표평분(modified Rankin Scale,mRS)분위호전조(0～3분)화불량전귀조(4～6분),대량조입원시GCS、NIHSS평분진행회고성분석.결과 불량전귀조중GCS분치저우호전조(P<0.01);NIHSS분치균고우호전조(P=0.011).경Logistic회귀교정년령、성별급치료방식3개인소후,GCS평분OR치0.301(95% CI 0.167～0.542);NIHSS평분OR치1.436(95% CI 1.147～1.796), 이자균위독립예측인소.ROC곡선분석현시,이GCS분치10분작위예측TOBS예후적계점,기령민도87.9%,특이도83.9%;이NIHSS분치14분작위계점,령민도63.6%,특이도77.4%.결론 GCS、NIHSS균시기저동맥첨종합정전귀중요적예측지표;GCS≤10분、NIHSS≥14분대우기저동맥첨종합정환자불량전귀균유중요적예측개치,GCS예측효개고우NIHSS.
Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.