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目的 评价脑血管血液动力学检测预警卒中的真实性和可靠性指标及最佳截断点。方法 以整群抽样的方法抽取东北等地区 35岁及以上的人群 2 0 333例 ,在脑血管病危险因素基线调查时全部接受脑血管血液动力学检测 ,并对诸指标的检测结果进行总积分。检测随访目标人群卒中发病 ,随访 4年共发生确诊卒中患者 16 8例 ,以随访中临床卒中发生为金标准 ,用筛检试验方法评价脑血管血液动力学检测积分的预警效能及最佳截断点。结果 经过绘制受试者工作特征 (ROC)曲线 ,血液动力学检测预警卒中的最佳积分值截断点应为 75分以下。以 75分为截断点 ,脑血液动力学检测后 4年内预警卒中的敏感度、特异度、准确度、阳性预告值、阴性预告值、阳性似然比、阴性似然比和Youden指数分别为 87.5 0 %、6 7.70 %、6 7.86 %、2 .2 1%、99.85 %、2 .71、0 .18和 0 .5 5 ,其中预警脑血栓的敏感度和阳性预告值高于预警脑出血 ,在具有危险因素暴露的卒中高危人群中 ,阳性预告值是普通人群的 2～ 3倍。脑血管血液动力学临床检测积分值的变异系数为 4 .0 3% ,两名医师临床检测积分值判定的符合率为 97.6 2 % ,Kappa值为0 .94。结论 血液动力学检测对卒中具有良好的预警效果 ,其中脑血栓的预警效果优于脑出血。最佳分值截断点为 75分?
Objective To evaluate the authenticity and reliability of cerebrovascular hemodynamics in predicting stroke and the best cutoff point. Methods A total of 2033 cases of people aged 35 and over in Northeast China and other regions were collected by cluster sampling method. All patients underwent cerebrovascular hemodynamic tests during the baseline survey of risk factors for cerebrovascular disease. The total score . A total of 16 8 confirmed stroke patients were followed up for 4 years. According to the clinical criteria of stroke at follow-up, the early warning efficacy and best cutoff point of cerebral vascular hemodynamic test scores were evaluated by screening test . Results After the receiver operating characteristic (ROC) curve was plotted, the cut-off point of the best integral value for hemodynamic prediction of stroke should be below 75 points. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and Youden index of pre-stroke stroke within 4 years after cerebral hemodynamics test were 75.5 0%, 6 7.70%, 6 7.86%, 2.21%, 99.85%, 2.71,0.18 and 0 .5 5, respectively. The sensitivity and positive predictive value of early warning cerebral thrombosis were higher than those of premature cerebral hemorrhage, In risk groups exposed stroke risk groups, the positive predictive value is 2 to 3 times the general population. The coefficient of variation (CV) of the integral value of the cerebral vascular hemodynamics clinical examination was 4.3%. The coincidence rate of the two physicians’ clinical evaluation integral values was 97.6% and the Kappa value was 0.94. Conclusion Hemodynamic tests have a good early warning effect on stroke, and the early warning effect of cerebral thrombosis is better than cerebral hemorrhage. The best score truncation point is 75 points?