ASTRAL评分预测急性缺血性卒中患者3个月预后的价值

目的 探讨洛桑卒中量表（Acute Stroke R egistry and Analysis of Lausanne，ASTRAL）评分预测不同 性别、不同梗死部位、不同病情严重程度急性缺血性卒中（acute i schemi c stroke，AI S）患者3个月预后 的价值，并与PLAN（Preadmission Comorbidities，Level of Consciousness，Age，Neurologic Deficit，PLAN）评 分、血管事件总体健康风险（Totaled Health Risks in Vascular Events，THRIVE）评分对急性缺血性卒中 3个月预测价值进行比较。 方法 记录符合纳入标准的急性缺血性卒中患者的基线资料，按照性别、梗死部位、病情严重程度 进行分组，然后记录并分别使用ASTRAL评分、PLAN评分与THRIVE评分预测患者3个月预后。通过受 试者工作特征曲线下面积（area under the receiver operating characteristic curve，AUC）进行Z 检验来比 较它们的预测价值。 结果 ①本研究共纳入513例AIS患者，男性309例、女性204例；梗死部位：前循环305例，后循环153 例，混合型55例；病情轻重程度：轻型卒中260例，非轻型卒中253例；②ASTRAL预测所有入组AIS患 者的AUC为0.845，预测男性组AUC为0.804，女性组AUC为0.878，两者比较Z 值为1.86（P ＞0.05）；预 测前循环组AUC为0.843、后循环组AUC分别为0.857、混合组AUC为0.814，三者比较Z 值均＜1.98（P ＞0.05）；预测轻型卒中AUC为0.714、非轻型卒中AUC为0.855，两者比较Z 值为4.03，其值＞1.98（P值 为0.000）。ASTRAL评分、PLAN评分、THRIVE评分预测所有入组AIS患者的AUC分别为0.845、0.783和 0.740，三者比较Z值均＞1.98（P值分别为0.000、0.010和0.000）。 结论 ASTRAL评分可对AIS患者3个月预后进行预测，更适合非轻型AIS患者，预测价值高于PLAN评分、 THRIVE评分。

The Value of ASTRAL Score in Predicting Three Months Prognosis of Acute Ischemic Stroke

Objective To explore the value of ASTRAL score in predicting prognosis of patients with the different gender, different infarction parts and disease severity at 3-months after onset of acute ischemic stroke (AIS), and compare with the value of predicting of Preadmission Comorbidities, Level of Consciousness, Age, Neurologic Deficit (PLAN) score, and Totaled Health Risks in Vascular Events (THRIVE) score.
Methods Related baseline data were recorded and ASTRAL score, PLAN score and THRIVE score were calculated respectively based on different groups according to gender, infarction area, and disease severity, to compare the predictive value of ASTRAL score with PLAN score and THRIVE score in patients with AIS at three months after onset. Model discrimination was quantified by calculating the area under the receiver operating characteristic curve (AUC), and compared their predictive value by conducting Z test.
Results (1) A total of 513 patients with AIS were enrolled, including 309 cases of male and 204 cases of female;Infarction parts:there were 305 cases of anterior circulation infarction, 153 cases of posterior, and 55 cases of mixed anterior and posterior;Illness severity:there were 260 cases of minor strokes, and 253 cases of non-minor stroke. (2) The AUC of ASTRAL predicting 3 months prognosis in all patients is 0.845. AUC in male group was 0.804, and in female group was 0.878, which showed the Z value of 1.86 (P>0.05);the AUC of predicting anterior, posterior and mixed circulation group were 0.843, 0.814 and 0.857 respectively, with Z values<1.98 (P>0.05). The AUC of predicting minor stroke and non-minor stroke were 0.714 and 0.855 respectively, and the Z value was 4.03 (P=0.000). The AUC of ASTRAL score, PLAN score and THRIVE score predicting all patients were 0.845, 0.783, 0.740, respectively, with Z value>1.98 (P values were 0.000, 0.010, 0.000). Conclusion ASTRAL score could predict 3 months prognosis in patients with AIS, which performs better in predicting minor stroke than PLAN score and THRIVE score.