首页|肌少症指数对老年急性缺血性脑卒中患者预后的预测价值研究

肌少症指数对老年急性缺血性脑卒中患者预后的预测价值研究

Predictive Value of Sarcopenia Index for Prognosis in Elderly Patients with Acute Ischemic Stroke

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背景 老年急性缺血性脑卒中(AIS)患者预后不良给公共卫生带来巨大压力,积极寻找简便、易操作的临床指标来筛选预后不良的高危人群已成为热点.目的 分析肌少症指数(SI)对老年AIS患者预后的预测价值.方法 选取 2021 年 7 月—2022 年 6 月在常州市金坛第一人民医院住院的老年AIS患者 280 例,根据改良Rankin量表(mRS)将患者分为预后不良组(≥3 分)和预后良好组(≤2 分),比较两组的基线资料及入院和出院时的美国国立卫生研究院卒中量表(NIHSS)评分.采用多因素Logistic回归分析探究影响老年AIS患者预后的因素,并绘制受试者工作特征(ROC)曲线分析SI预测老年AIS患者预后不良的价值.结果 预后良好组 212 例,预后不良组 68 例.预后不良组与预后良好组患者糖尿病史、既往脑卒中史、中性粒细胞计数(NE)、淋巴细胞计数(LY)、白蛋白(ALB)、入院NIHSS评分、出院NIHSS评分、SI比较,差异有统计学意义(P<0.05).Spearman秩相关分析结果显示,SI与老年AIS患者mRS评分(rs=-0.195,P=0.001)、入院NIHSS评分(rs=-0.163,P=0.006)、出院NIHSS评分呈负相关(rs=-0.205,P=0.001).多因素Logistic回归分析结果显示,SI是影响老年AIS患者预后的独立影响因素(OR=0.959,95%CI=0.927~0.992,P=0.015).ROC曲线分析显示,SI预测老年AIS患者预后不良的ROC曲线下面积(AUC)为0.694(95%CI=0.619~0.769),灵敏度为 69.3%,特异度为 64.7%,截断值为 63.46;根据SI的四分位数将入组患者分为Q1、Q2、Q3、Q4 组,每组 70 例,Q1、Q2、Q3、Q4 组年龄、心房颤动史、既往脑卒中史、尿酸(UA)、同型半胱氨酸(Hcy)、mRS评分、入院NIHSS评分、出院NIHSS评分比较,差异有统计学意义(P<0.05).结论 老年AIS患者预后不良组的SI明显减低,SI是老年AIS患者预后不良的独立影响因素,有较好的预测价值.
Background Poor prognosis in elderly patients with acute ischemic stroke(AIS)has put great pressure on public health.Actively searching for simple and easy-to-operate clinical indicators to screen high-risk groups with poor prognosis has become a hot issue.Objective To analyze the predictive value of sarcopenia index(SI)on the prognosis of elderly patients with AIS.Methods A total of 280 elderly AIS patients hospitalized in Changzhou Jintan First People's Hospital from July 2021 to June 2022 were selected and divided into the poor prognosis group(≥3 points)and good prognosis group(≤2 points)according to the Modified Rankin Scale(mRS).Baseline data and National Institutes of Health Stroke Scale(NIHSS)scores at admission and discharge were compared between the two groups.Multivariate Logistic regression analysis was used to explore the factors affecting the prognosis of elderly patients with AIS,and a receiver operating characteristic(ROC)curve was plotted to analyze the value of SI in predicting poor prognosis in elderly patients with AIS.Results There were 212 cases in the good prognosis group and 68 cases in the poor prognosis group.There were significant differences in the history of diabetes and previous stroke,neutrophil count(NE),lymphocyte count(LY),albumin(ALB),admission NIHSS score,discharge NIHSS score,and SI between patients between the poor prognosis group and good prognosis group(P<0.05).Spearman rank correlation analysis results showed that SI was negatively correlated with the prognostic mRS score(rs=-0.195,P=0.001),admission NIHSS score(rs=-0.163,P=0.006),and discharge NIHSS score(rs=-0.205,P=0.001).The results of multivariate Logistic regression analysis showed that SI was an independent factor affecting the prognosis of elderly patients with AIS(OR=0.959,95%CI=0.927-0.992,P=0.015).ROC curve analysis showed that the area under the ROC curve(AUC)for SI to predict poor prognosis in elderly AIS patients was 0.694(95%CI=0.619-0.769),with a sensitivity of 69.3%,specificity of 64.7%,and cutoff value of 63.46;the enrolled patients were divided into Q1,Q2,Q3,and Q4 groups according to the quartiles of SI,with 70 cases in each group,there were significant differences in the age,history of AF and previous stroke,UA,Hcy,mRS score,admission NIHSS score,and discharge NIHSS score among the Q1,Q2,Q3,and Q4 groups(P<0.05).Conclusion SI is significantly reduced in the poor prognosis group of elderly AIS patients.SI is an independent influencing factor for poor prognosis in elderly AIS patients with good predictive value.

Ischemic strokeAgedAcute ischemic strokeSarcopenia indexPrognosisRetrospective studyLogistic models

谢翼、徐俊马、胥方琴、俪超、陈辰、邵婵

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213200 江苏省常州市金坛第一人民医院老年医学科

缺血性卒中 老年人 急性缺血性脑卒中 肌少症指数 预后 回顾性研究 Logistic模型

江苏省卫生与健康委员会老年健康科研项目

LR2021044

2024

中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
年,卷(期):2024.27(11)
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