洛杉矶院前卒中筛查量表对脑卒中评估的价值

目的研究洛杉矶院前卒中筛查量表(LAPSS)对院前脑卒中评估的价值。方法入组病例选择院前接诊的以神经系统局灶症状或体征为主要表现的92例患者,通过LAPSS进行卒中筛查,探讨LAPSS对院前卒中预后的影响。结果通过LAPSS筛查,判断为"目标卒中"者49例。LAPSS筛查平均时间为280 s。经最后临床确诊后,发现漏诊4例,误诊4例。LAPSS筛查的灵敏度91.8%,特异度90.7%,Youden指数0.83,阳性似然比9.87,阴性似然比0.09。结论LAPSS在院前卒中诊断中具有较高的特异性和敏感性,有助于快速、准确判断卒中,对脑卒中患者的院前救护有重要意义。     

洛杉矶院前卒中筛查量表在院前卒中的应用研究

目的探讨洛杉矶院前卒中筛查量表(LAPSS)在院前卒中诊断中的早期诊断价值。方法入组病例选择院前接诊的以神经系统局灶症状或体征为主要表现的92例患者,通过LAPSS进行卒中筛查。结合最终临床诊断,评价LAPSS对院前卒中诊断价值。结果①92例患者临床诊断为卒中49例,其中24例为出血性卒中,25例缺血性卒中。漏诊4例,误诊4例,漏诊或误诊原因均与神经系统查体有关;②LAPSS筛查的统计学分析:灵敏度91.8%,特异度90.7%,漏诊率8.2%;误诊率9.3%,Youden指数0.83,阳性似然比9.87,阴性似然比0.09。完成LAPSS筛查平均时间为4分42秒。结论 LAPSS在院前卒中诊断中具有较高的特异性和敏感性,急诊时可快速、准确判断卒中,值得院前急诊推广。     

卒中单元对急性脑卒中患者近期预后的影响

目的 探讨卒中单元对急性脑卒中患者近期预后的影响.方法 196例急性脑卒中患者(脑出血59例,脑梗死137例)随机分为卒中单元组(101例)和普通病房组(95例),并进行相应的治疗.比较两组治疗后与治疗前美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)的差值及疗效,以及并发症的发生率.结果 与治疗前比较,卒中单元组治疗后NIHSS评分降低(12.6± 5.5)分,普通病房组降低(8.9 ±4.1)分;卒中单元组BI升高24.3±14.8,普通病房组升高15.1±10.6;两组间差异有统计学意义(均P<0.05).卒中单元组基本痊愈率、总有效率、并发症发生率及病死率(27.7%、97.0%、10.9%及2.0%)与普通病房组(15.8%、88.4%、23.2%及8.4%)比较差异均有统计学意义(均P<0.05).结论 卒中单元能明显改善急性脑卒中患者的近期预后.     

Padua血栓评估模型对脑卒中患者静脉血栓栓塞症的评估价值

目的探究Padua血栓评估模型对脑卒中患者并发静脉血栓栓塞症(VTE)风险的预测价值。方法选择2018年1月至2019年6月共169例脑卒中患者,其中并发VTE者(血栓组)56例,未并发VTE者(对照组)113例。比较两组患者Padua血栓评估模型中危险因素的分布差异,采用单因素和多因素前进法Logistic回归分析筛查脑卒中患者并发VTE的危险因素;采用Padua血栓评估模型对患者进行VTE风险分层,以不同分值作为风险分层的界值拟合受试者工作特征(ROC)曲线,评价Padua血栓评估模型预测脑卒中并发VTE的效能。结果血栓组患者房颤(P=0.024)、高龄(P=0.000)、心力衰竭和(或)呼吸衰竭(P=0.000)、急性感染性和(或)风湿性疾病(P=0.000)、活动性恶性肿瘤/化疗(P=0.016)、既往VTE史(P=0.007)、活动减少(P=0.009)比例均高于对照组。Logistic回归分析显示,房颤(OR=3.203,95%CI:1.172～8.751;P=0.023)、高龄(OR=3.469,95%CI:1.063～7.580;P=0.002)、心力衰竭和(或)呼吸衰竭(OR=4.017,95%CI:1.315～12.274;P=0.015)、急性感染性和(或)风湿性疾病(OR=3.472,95%CI:1.457～8.271;P=0.005)、既往VTE史(OR=5.884,95%CI:1.068～32.408;P=0.042)是脑卒中并发VTE的危险因素。ROC曲线显示,Padua血栓评估模型风险分层界值为4分时,曲线下面积为0.762、标准误为0.040(95%CI:0.689～0.854,P=0.000),其灵敏度、特异度、阳性预测值、阴性预测值分别为71.43%、69.02%、53.34%、83.08%,Youden指数为0.404,Padua血栓评估模型风险分层界值为4分对脑卒中并发VTE的预测价值最优。结论高龄、既往VTE史和危重型脑卒中是VTE的高危因素,基于Padua血栓评估模型能够有效预测脑卒中并发VTE的风险。     

A2DS2评分诊断中国缺血性脑卒中相关性肺炎准确性的Meta分析

目的评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性及临床适应性。方法通过检索Medline、PubMed、Embase、Cochrane、Web of Science、万方、中国知网、维普、中国生物医学数据库自建库至2020年2月发表的文献,筛选应用A2DS2评分预测中国缺血性脑卒中患者发生肺炎的相关文献,采用QUADAS-2风险评估标准对纳入文献进行质量评价,采用Meta分析评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性,采用Deek检验评价文献发表偏倚,采用范根图评价A2DS2评分的临床适用性。结果最终纳入12篇文献,共7719例患者。Meta分析显示A2DS2评分的诊断比值比(DOR)为18(95%CI:12~27),合并灵敏度为0.76(95%CI:0.68~0.82),合并特异度为0.85(95%CI:0.80~0.88),合并阳性似然比为5.02(95%CI:3.91~6.44),合并阴性似然比为0.29(95%CI:0.22~0.38)。A2DS2评分诊断中国缺血性脑卒中相关性肺炎的综合受试者工作特征(SROC)曲线的曲线下面积(AUC)为0.88(95%CI:0.85~0.91)。Deek检验结果显示各纳入文献无明显发表偏倚(P>0.05)。范根图显示A2DS2评分的临床适用性较好。结论A2DS2评分对中国缺血性脑卒中相关性肺炎具有较好的诊断价值,可用于临床初步筛查缺血性脑卒中相关性肺炎患者。     

三种卒中筛查量表在社区疑诊卒中患者快速转诊中应用价值的对比研究

目的 探讨FAST、急诊卒中识别（recognition of stroke in the emergency room,ROSIER）、洛杉矶院前 卒中筛查（Los Angeles prehospital stroke screen,LAPSS）三种卒中筛查量表在社区疑诊卒中患者快速 转诊中的应用价值。 方法 纳入2018年1月-2019年9月在北京市昌平区东小口社区卫生服务中心和延庆区永宁社区卫生 服务中心就诊的疑似卒中患者,分别用FAST、ROSIER、LAPSS三种量表进行卒中初筛,按照上级医院 患者最终诊断分为卒中组和非卒中组,比较三种评价量表筛查卒中的准确率、灵敏度和特异度。 结果 共纳入309例患者,平均年龄70.5±11.6岁,其中男性156例（50.5%）。卒中组243例（78.6%）, 非卒中组66例（21.4%）。FAST、ROSIER和LAPSS三种量表筛查卒中的准确率分别为92.2%、71.5%、 67.3%（P＜0.001）,灵敏度分别为94.2%、66.3%、60.5%（P＜0.001）,特异度分别为84.8%、90.9%、 92.4%（P =0.327）;进一步两两比较,FAST量表准确率、灵敏度均高于ROSIER和LAPSS量表（均P ＜0.001）。 结论 FAST量表的应用价值较好,适合社区医生作为初诊疑似卒中患者快速转诊的判断工具。     

脑卒中后抑郁与卒中部位关系探讨

目的 研究首发脑卒中患者第4周脑卒中后抑郁与卒中部位的关系.方法 共调查127例患者,其中113例完成所有调查,将诊断为PSD的患者列为PSD组,其余患者为非PSD组.比较2组的卒中性质和卒中部位.结果 从卒中病灶发生的部位看,左侧病灶发病率(59.18%)高于右侧病灶(38.16%),前部病灶(50.85%)高于后部病灶(29.63%).皮层病灶(57.14%)高于皮层下病灶(33.80%).2组病灶数目比较,多灶患者PSD的发生率(59.68%)明显高于单灶患者(37.25%)(P<0 .05).卒中性质与PSD无明显关系(χ2＝3.86,P>0.05).结论 脑卒中后抑郁与卒中部位存在关系.     

白细胞介素-1β值对缺血性脑卒中后疲劳发生的预测价值研究

目的分析白细胞介素-1β(1L-1β)值对缺血性脑卒中后疲劳(PSF)发生的预测价值。方法选取2013年1月-2016年12月首次发病且发病后24h内入院的缺血性脑卒中患者156例,记录患者临床资料,包括性别、年龄、体质量、身高、病程、病变部位、吸烟、饮酒、既往史及家族史、并发症、血压,检测空腹血糖、血脂、1L-1β。随访3个月,再对其进行疲劳严重度测评,疲劳严重度量表(FSS)≥4分诊断为疲劳,绘制受试者工作特征曲线,计算1L-1β预测缺血性PSF发生的敏感度、特异度、阳性预测值和阴性预测值。结果 156例缺血性脑卒中患者,随访3个月后,发生缺血性PSF 67例,未发生缺血性PSF89例,两组患者性别、年龄、体质量、病程、病变部位、糖尿病、冠心病、面瘫、肢体瘫痪、血糖、三酰甘油、低密度脂蛋白、1L-1β比较,差异有统计学意义(P0.05)。绘制受试者工作特征曲线,1L-1β预测缺血性PSF发生的敏感度为80.60%、特异度为80.90%、阳性预测值为76.06%、阴性预测值为84.71%。结论缺血性PSF患者1L-1β升高,1L-1β可作为早期预测缺血性脑卒中患者是否发生缺血性PSF的指标。     

颈部血管多普勒超声、数字减影血管造影、磁共振血管成像在颈动脉狭窄检查中的对比研究

目的对比分析颈部彩色多普勒超声(CDUS)、数字减影血管造影(DSA)以及磁共振血管成像(MRA)在颈动脉狭窄度评估方面的差异。方法回顾性分析81例经DSA诊断为颈动脉狭窄患者的临床资料,将其CDUS和MRA的数据与DSA结果进行比较,评价各种影像学检查在颈动脉血管狭窄及斑块检出中的敏感度、特异度和符合率。结果以狭窄率30%、50%、70%分别为节点,MRA、CDUS与DSA 3种方法检出的敏感度分别为78%、85%、73%,特异度分别为99%、98%、96%,符合率分别为90%、92%、91%,阴性预测率分别为94%、93%、90%,阳性预测率分别为95%、96%、90%,阳性似然比分别为77.8、42.5、18.25。MRA与DSA比较,敏感度分别为65%、89%、79%,特异度分别为95%、96%、98%,准确度分别为85%、92%、93%,阴性预测率分别为94%、95%、93%,阳性预测率分别为90%、93%、94%,阳性似然比分别为13.0、21.5、9.5。结论诊断颈动脉狭窄病变时,MRA特异度高,与DSA检测结果一致性较好;MRA与DSA的一致性较CDUS强。     

轻型缺血性脑卒中患者卒中后抑郁的相关因素研究

目的探讨轻型缺血性脑卒中患者卒中后抑郁(post-stroke depression,PSD)的相关因素。方法连续选取2017-08-2018-10就诊于中国人民解放军联勤保障部队第989医院的首发轻型缺血性脑卒中患者共150例,采用HAMD评分将其分为PSD组55例和N-PSD组95例。结果轻型缺血性脑卒中患者PSD的发生率为36.7%,组间比较发现女性(P=0.014,OR=1.169,95%CI 1.210～3.664)和2型糖尿病(P=0.021,OR=4.813,95%CI 2.180～7.964)为PSD的独立危险因素。2组不同卒中部位的比较无统计学意义(P0.05)。PSD组社会支持总分、主观支持和支持利用度明显低于N-PSD组(P0.05)。结论轻型缺血性脑卒中患者PSD的发生率较高,女性、2型糖尿病、缺乏社会支持可能是其危险因素,并未发现卒中部位与PSD的发生有关。     

Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS)

BACKGROUND AND PURPOSE: Reliable identification of stroke patients in the field by prehospital personnel could expedite delivery of acute stroke therapy. The Los Angeles Prehospital Stroke Screen (LAPSS) is a 1-page instrument designed to allow prehospital personnel to rapidly identify acute stroke patients in the field. We performed a prospective, in-the-field validation study of the LAPSS. METHODS: Paramedics assigned to 3 University of California at Los Angeles-based advanced life support units were trained and certified in use of the LAPSS. Over 7 months, paramedics completed the LAPSS on noncomatose, nontrauma patients with complaints suggestive of neurological disease. LAPSS form stroke identification results were compared with emergency department and final hospital discharge diagnoses. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios were calculated for LAPSS identification of ischemic stroke, currently symptomatic transient ischemic attack, and intracerebral hemorrhage. RESULTS: Of a total of 1298 runs, 34% were for nontraumatic, noncomatose neurologically relevant complaints. Thirty-six of these patients (3% of all transports) had a final diagnosis of acute symptomatic cerebrovascular disease (21 ischemic strokes, 7 transient ischemic attacks, and 8 intracerebral hemorrhages). LAPSS forms were completed on 206 patients. Paramedic performance when completing the LAPSS demonstrated sensitivity of 91% (95% CI, 76% to 98%), specificity of 97% (95% CI, 93% to 99%), positive predictive value of 86% (95% CI, 70% to 95%), and negative predictive value of 98% (95% CI, 95% to 99%). With correction for the 4 documentation errors, positive predictive value increased to 97% (95% CI, 84% to 99%). CONCLUSIONS: The LAPSS allows prehospital personnel to identify patients with acute cerebral ischemia and intracerebral hemorrhage with a high degree of sensitivity and specificity.     

Evaluating the performance of the PRISMA-7 frailty criteria for predicting disability and death after acute ischemic stroke

ObjectivesWe aimed to evaluate the predictive performance of the PRISMA-7 frailty criteria regarding the composite outcome of disability or death in patients with an acute ischemic stroke, and to compare it with the Frailty Index and the National Institutes of Health Stroke Scale (NIHSS).Materials and methodsThis prospective cohort study involved all patients aged ≥ 40 years admitted with an acute ischemic stroke between March 2019 and January 2020. We performed survival analyses, calculated risk ratios, sensitivity, specificity, and predictive values for the combined outcome of disability or death according to the presence of frailty as determined by the PRISMA-7 and the Frailty Index, and stroke severity based on the NIHSS.ResultsIn 174 patients with acute ischemic stroke, being frail in the week before the stroke according to the PRISMA-7 was associated with a Risk Ratio of 4·50 (95%CI 1·77-11·43, P <0·001) and a Positive Predictive Value of 89% (95%CI 77-99%) for being disabled or dead 90 days after the stroke, and a Hazard Ratio of 3·33 (95%CI 1·48-7·51, P = 0·004) for the survival outcome. The predictive performance of the PRISMA-7 was not significantly different from the Frailty Index or the NIHSS.ConclusionsWe provide evidence that the PRISMA-7 frailty criteria may be a useful prognostication tool in acute ischemic stroke.     

Performance of dual layer dual energy CT virtual monoenergetic images to identify early ischemic changes in patients with anterior circulation large vessel occlusion

Background and purposeDual energy CT is increasingly available and used in the standard diagnostic setting of ischemic stroke patients. We aimed to evaluate how different dual energy CT virtual monoenergetic energy levels impact identification of early ischemic changes, compared to conventional polyenergetic CT images.Materials and methodsThis retrospective single-center study included patients presenting with acute ischemic stroke caused by an occlusion of the intracranial internal carotid artery or proximal middle cerebral artery. Data was gathered on consecutive patients admitted to our institution who underwent initial diagnostic stroke imaging with dual layer dual energy CT and a subsequent follow-up CT one to three days after admission. Automated ASPECTS results from conventional polyenergetic and different virtual monoenergetic energy level reconstructions at admission were generated and compared to reference standard ASPECTS. Confidence intervals (CI) for sensitivity, specificity, negative and positive predictive value were calculated.ResultsA total of 24 patients were included. Virtual monoenergetic reconstructions of 70 keV had the highest region-based ASPECTS accuracy, 0.90 (sensitivity 0.82 (95% CI 0.72–0.93), specificity 0.92 (0.88–0.97), negative predictive value 0.94 (0.90–0.96)), whereas virtual monoenergetic reconstructions of 40 keV had the lowest, 0.77 (sensitivity 0.34 (0.26–0.42), specificity 0.90 (0.89–0.96), negative predictive value 0.80 (0.77–0.83)).ConclusionsAutomated 70 keV ASPECTS had the highest diagnostic accuracy, sensitivity and negative predictive value overall. Our results indicate that virtual monoenergetic energy levels impact the identification of early ischemic changes on CT.     

Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients

Background and purposean estimated 40-80% of acute ischemic stroke patients have dysphagia and about 14% develop stroke-associated pneumonia. However, it may be difficult to detect swallowing problems at admission. Moreover, there might not be an on-duty specialist skilled in the diagnosis of this condition. This study aimed at developing a user-friendly bedside examination to identify the risk of dysphagia in stroke patients at hospital admission.Methodsa diagnostic accuracy study was carried out to assess the concurrent validity of a simple Bedside Screening Tool for Dysphagia (BSTD) in acute stroke. All the consecutive stroke patients admitted between January and April 2018 were enrolled. Sensitivity, specificity, positive (PPV), negative predictive values (NPV) and the Cohen K concordance index scores, reported by nurses and speech-pathologists, were assessed.Resultsa total of 67/120 patients (55.8%) were male; overall average age was 67.4 (range 45-91) and 80.8% of the whole population had a history of ischemic stroke. The nursing staff identified 33.3% of dysphagia cases at admission and the speech pathologists 30%. The Cohen K was 0.92 (optimal concordance when K was > 0.8), sensitivity was 100%, specificity 95.2%, PPV 90% and NPV 100%.Conclusionsour BSTD had a 100% negative predictive value, indicating that this screening test is very useful in ruling out/confirming dysphagia in acute stroke patients     

急性缺血性卒中患者行阿替普酶静脉溶栓治疗住院期间脑出血预测模型研究

目的 基于机器学习算法对急性缺血性卒中（acuteischemicstroke,AIS）或TIA患者行rt-PA静脉溶栓治疗住院期间脑出血的发生情况进行预测,并探索影响rt-PA溶栓治疗后脑出血发生的危险因素。方法 纳入中国卒中中心联盟（ChineseStrokeCenterAlliance,CSCA）2016年1月—2020年12月登记的被初步诊断为AIS或TIA且接受rt-PA静脉溶栓治疗的患者74 654例,平均年龄为（65.55±12.14）岁,其中,男性患者48 493例（64.96%）,住院期间发生脑出血患者2038例（2.73%）。将数据按年份划分为训练集和测试集,即2016—2019年登记患者划分为训练集,2020年登记患者划分为测试集,采用原型选择下采样技术对训练集数据正负样本进行77∶100平衡处理,构建了逻辑回归、极致梯度提升（extreme gradient boosting,XGBoost）、随机森林、梯度提升决策树（gradient boosting decision tree,GBDT）和分类梯度提升（categoricalboosting,CatBoos...     

大脑后动脉偏侧优势对同侧大脑中动脉病变卒中严重程度及预后的影响

目的探讨同侧大脑后动脉偏侧优势(posterior cerebral artery laterality,PCAL)对同侧大脑中动脉(middle cerebral artery,MCA)M1段严重狭窄或闭塞后急性卒中患者梗死范围、卒中严重程度和短期预后的影响。方法于2010年1月-2015年11月,前瞻性连续性纳入郑州大学第一附属医院MCA M1段严重狭窄(狭窄率70%~90%)或闭塞的161例急性缺血性卒中患者,根据患者有无PCAL分组,比较两组临床基线资料及3个月随访改良Rankin量表(modified Rankin scale,mRS)评分的差异。结果 161例患者中共76例PCAL阳性,85例PCAL阴性。PCAL阳性组既往卒中者少(P=0.021),基于弥散加权成像的Alberta卒中项目早期CT评分(diffusion weighted imaging-Alberta Stroke Programme Early CT Score,DWI-ASPECTS)更高(P=0.045),出院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分更低(P=0.009),3个月mRS评分更低(P=0.002),临床短期预后更好,差异有显著性。多因素Logistic回归分析可见,入院NIHSS评分[OR(odds ratio)1.266,95%CI(confidence interval)1.139~1.407,P0.01]是预后不良的预测因子,PCAL阳性(OR 0.355,95%CI 0.146~0.864,P=0.022)是预后良好的预测因子。结论 MCA M1段严重狭窄或闭塞的急性缺血性卒中患者,PCAL阳性者梗死范围更小,短期临床预后更好。     

Computed tomographic angiography for patients with acute spontaneous intracerebral hemorrhage

With the advanced technology of multi-slice CT scans, we explored the effectiveness of CT angiography (CTA) in place of digital subtraction angiography (DSA) in patients with acute spontaneous intracerebral hemorrhage (ICH). We performed a computerized PubMed search of the literature from inception to 27 July 2011 to find reports of similar comparative studies and performed a meta-analysis of diagnostic accuracy. The pooled sensitivity was 97.0% (95% confidence interval [CI]: 93.2-99.1%), specificity was 98.9% (95% CI: 97.0-99.7%), accuracy was 98.2% (95% CI: 96.6-99.2%), positive predictive value was 97.8% (95% CI: 94.2-99.5%) and negative predictive value was 98.5% (95% CI: 96.6-99.5%). The false negative rate was 1% (95% CI: 0.4-2.6%). We concluded that CTA with venography could replace DSA as the initial vascular investigation in patients presenting with spontaneous ICH during the acute phase. Future studies should focus on whether refinement of the techniques could preclude the false negative results.     

Comparison of Prediction Models based on Risk Factors and Retinal Characteristics Associated with Recurrence One Year after Ischemic Stroke

Objectives: To develop risk estimation models for 1-year ischemic stroke recurrence using clinical risk factors and retinal characteristics. Methods: From June 2017 to January 2019, 332 patients with first-ever ischemic stroke were enrolled and followed up in the Shenzhen Traditional Chinese Medicine hospital in China. The primary endpoint was defined as fatal or recurrent stroke after 1 year of the index stroke. Clinical risk factors and retinal characteristics were identified by multivariate logistic models. Results: The multivariate logistic model with only clinical risk factors showed that Cerebral Atherosclerosis (OR 1.68, 95%CI: 1.000-2.81), white matter lesions (OR 3.61, 95%CI: 2.18-5.98), and Cardiac disease (OR 1.88, 95%CI: 1.02-3.46) were statistically significantly associated with higher stroke recurrence risk. The sensitivity and specificity of this model were 69.1% and 68.4% respectively. The multivariate logistic model with only retinal characteristics showed that central retinal venule equivalent (OR .34, 95%CI: .14-.83), hemorrhage (OR .6, 95%CI: .41-.88), exudate (OR 1.64, 95%CI: 1.16-2.32), central retinal artery equivalent (OR 2.95, 95%CI: 1.23-7.08), and Aangle (OR 0.8, 95%CI: .61-1.004) were statistically significantly associated with stroke recurrence. The sensitivity and specificity of the model were 62.0% and 64.4% respectively. The multivariate logistic model with both clinical risk factors and retinal characteristics showed that cerebral atherosclerosis (OR 1.74, 95%CI: 1.020-2.981), white matter lesions (OR 3.65, 95%CI: 2.17-6.13), cardiac disease (OR 1.99, 95%CI: 1.06-3.74), hemorrhage (OR .68, 95%CI: .49-.96), exudate (OR 1.65, 95%CI: 1.16-2.36) were independent risk factors of stroke recurrence. The sensitivity and specificity of the model were 72.5% and 70.7% respectively. Conclusions: Combining the traditional risk factors of stroke with the retinal vessels characteristics to establish the recurrent cerebral infarction prediction model may improve the accuracy of the prediction.     

大脑中动脉高密度征与磁敏感血栓征对大脑中动脉闭塞比较研究

目的比较研究大脑中动脉高密度征(HMCAS)和磁敏感血栓征(SVS)显示大脑中动脉(MCA)闭塞血栓的差异。方法回顾性分析41例临床及影像证实MCA近段闭塞急性脑梗死患者CT及MRI(包含SWI及MRA序列)影像资料。分析HMCAS、SVS显示责任血管血栓灵敏度、特异性、阳性预测值、阴性预测值及其相关性。结果 41例MCA区域急性脑梗死患者中,MRA显示27例同侧MCA近段闭塞,SWI显示21例SVS,CT显示22例HMCAS。HMCAS、SVS显示责任血管血栓灵敏度(78%,78%)、特异性(93%,100%)、阳性预测值(95%,100%)、阴性预测值(68%,70%)。在所有患者中,HMCAS与SVS对预测MCA近段是否闭塞具有高度的一致性(κ值分=0.853);在MRA证实MCA近段闭塞患者中,HMCAS与SVS有无对预测MCA近段是否闭塞具有良好的一致性(κ值分=0.786)。结论 HMCAS、SVS在显示MCA近段血栓具有较好的灵敏度及高度的特异性,并且两者之间具有良好的一致性。     

急性缺血性卒中相关肺炎评分临床应用价值分析

目的 验证急性缺血性卒中相关肺炎评分（Acute Ischemic Stroke-Associated Pneumonia Score,AISAPS） 对缺血性卒中相关肺炎的预测效果,为临床早期发现卒中相关性肺炎提供适合的筛查工具。 方法 从任丘康济新图医院缺血性卒中急性期干预、二级预防相关登记研究数据库中选取2014年 1月20日-2016年8月31日住院治疗的急性缺血性卒中患者,采用AIS-APS评分量表进行评分,应用ROC 曲线下面积确定AIS-APS对缺血性卒中相关肺炎预测的灵敏度与特异度,验证该量表的有效性,同时 验证ISAN[prestroke Independence（mRS）,sex,age,NIHSS]、A2DS2（age,atrial fibrillation,dysphagia,sex, stroke severity）、Kwon等评分量表对缺血性卒中患者发生卒中相关性肺炎的预测作用。 结果 共纳入3104例急性缺血性卒中患者,其中有100例（3.2%）发生肺炎;AIS-APS的ROC曲线下面 积为0.737（95%CI 0.721～0.753）,敏感度0.800,特异度0.611,Youden指数0.411,最佳界值为5分。与 其他评分量表相比,AI S-APS量表ROC曲线下面积、灵敏度最高,但ISAN量表特异度最高（0.759）。 结论 AIS-APS量表对于卒中相关性肺炎的预测有一定价值,可指导临床早期筛查卒中相关性肺炎。