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目的评价高超敏C反应蛋白、同型半胱氨酸和Essen评分法及联合应用对腔隙性脑梗死患者预后风险评估的临床价值。方法对125例腔隙性脑梗塞患者进行1年随访观察,通过应用受试者工作特征(ROC)曲线,计算ROC曲线下面积比较四种预测腔隙性脑梗死预后评分法的价值。结果 (1)125例患者中共失访7例,失访率5.6%。其余118例在随访1年中有17例因出现新的梗死病灶和(或)不良心脏事件而入院治疗;(2)Essen+CRP评分法、Essen评分法、CRP评分法和Essen+Hcy评分法的ROC曲线下面积(95%CI)分别为0.755(0.619～0.891)、0.730(0.595～0.865)、0.695(0.556～0.834)和0.725(0.587～0.863),Es-sen+CRP评分法优于其他三种评分法;(3)Essen+CRP评分法低危组(n=35)、高危组(n=67)和极高危组(n=16)心脑血管事件发生率分别为8.57%、11.94%和37.50%,3组比较差异明显(χ2=8.217,P<0.05)。结论 4种方法在评估腔隙性脑梗死预后方面均有一定的临床价值,但Essen+CRP评分法能更好地鉴别高危患者。
Objective To evaluate the clinical value of high-sensitivity C-reactive protein, homocysteine, Essen score and their combined application in assessing the prognosis of patients with lacunar infarction. Methods 125 patients with lacunar infarction were followed up for one year. The ROC curve was used to calculate the area under the ROC curve to compare the four prognostic value of lacunar infarction prognosis. Results (1) Among 125 patients, 7 cases were lost to followup and the rate of loss to follow up was 5.6%. The remaining 118 patients were admitted to hospital for treatment of new infarction and / or adverse cardiac events during the follow-up of 1 year. (2) Essen + CRP, Essen, CRP and Essen + Hcy The areas under the ROC curve (95% CI) were 0.755 (0.619-0.891), 0.730 (0.595-0.865), 0.695 (0.556-0.834) and 0.725 (0.587-0.863), respectively. (3) The incidence of cardiovascular and cerebrovascular events in the low risk group (n = 35), the high risk group (n = 67) and the very high risk group (n = 16) by Essen + CRP were 8.57% and 11.94 % And 37.50% respectively. The difference between the three groups was significant (χ2 = 8.217, P <0.05). Conclusion The four methods have some clinical value in assessing the prognosis of lacunar infarction. However, the Essen + CRP grading method can better identify high-risk patients.