目的 探讨V1导联P波终末电势（PTFV1）联合洛桑（ASTRAL）评分对急性缺血性卒中患者不良功能预后的预测价值。 方法 本研究是前瞻性队列研究，连续纳入2019年1月至2021年12月于郑州大学第一附属医院住院的发病7 d内的缺血性卒中患者。收集患者基线信息，测量患者PTFV1，计算ASTRAL评分。结局事件为1年不良功能预后（改良Rankin评分>2分）。通过建立Logistic回归模型，分析PTFV1对不良功能预后的预测价值。将PTFV1加入ASTRAL评分，拟合P-ASTRAL评分。通过绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），验证模型的预测价值。 结果 最终纳入3 399例患者，年龄（59±12）岁，年龄范围14~95岁。其中男占70.3%（2 390/3 399），PTFV1增大的比例为8.8%（299/3 399）。与改良Rankin评分≤2分的患者相比，功能预后不良患者年龄更大（t=12.40，P<0.001）、男性更多（χ2=23.85，P<0.001）、有更多的危险因素[糖尿病（χ2=5.54，P=0.019）、既往卒中病史（χ2=56.38，P<0.001）、冠心病（χ2=22.72，P<0.001）]、PTFV1增大的比例更多（χ2=229.65，P<0.001）及ASTRAL评分更高（χ2=424.02，P<0.001）。矫正混杂因素后，PTFV1增大（OR=4.168，95%CI 3.101~5.602，P<0.001）及ASTRAL评分增加（OR=1.122，95%CI 1.097~1.148，P<0.001）是会增加1年不良功能结局的风险。ASTRAL评分对1年不良功能预后的预测价值高于ASTRAL评分（AUC：0.753对0.739，Z=2.317，P=0.021）。 结论 PTFV1是缺血性卒中患者不良预后的危险因素，P-ASTRAL评分可以提高对缺血性卒中不良结局的预测价值。 Objective To investigate the predictive value of adding P-wave terminal force in lead V1 (PTFV1) to ASTRAL score for poor functional prognosis in patients with acute ischemic stroke. Methods The study was a prospective cohort study. The hospitalized ischemic stroke patients within 7 days of onset from January 2019 to December 2021 in The First Affiliated Hospital of Zhengzhou University were enrolled. The baseline characteristics were collected, the values of PTFV1 were measured, and ASTRAL scores were evaluated. The unfavorable outcome was defined as 1-year modified Rankin Scale score (mRS) >2. Logistic regression model was conducted to determine the association of PTFV 1 with unfavorable outcome. P-ASTRAL score was established by adding PTFV1 to ASTRAL score. The receiver operating characteristics (ROC) curves were plotted, and areas under the curves (AUC) were calculated to evaluate the prognostic significance. Results A total of 3 399 acute stroke patients were enrolled. The average age were (59±12) years old (range: 16-95 years), 70.3% (2 390/3 399) of patients were male, 8.8% (299/3 399) patients had an increased PTFV1 value. In comparison with patients with mRS≤2, patients with poor functional outcome were much older (t=12.40, P<0.001), had a higher proportion of male (χ2=23.85, P<0.001), had much more risk factors [diabetes mellitus (χ2=5.54, P=0.019), stroke history (χ2=56.38, P<0.001), coronary heart disease (χ2=22.72, P<0.001) ], had a higher proportion of increased PTFV1 value (χ2=229.65, P<0.001), and higher ASTRAL score (χ2=424.02, P<0.001). After adjusting confounding factors, PTFV1>5 000 μV·ms (OR=4.168, 95%CI 3.101-5.602, P<0.001) and ASTRAL score (OR=1.122, 95%CI 1.097-1.148, P<0.001) could increased the risk of 1-year poor functional outcome. TheAUC for P-ASTRAL score was higher than ASTRAL score (0.753 vs. 0.739, Z=2.317, P=0.021) . Conclusion PTFV1 was an independent risk factor of unfavorable outcome for stroke. P-ASTRAL score could improve the predictive value of poor functional outcome for ischemic stroke.
Abstract
Objective To investigate the predictive value of adding P-wave terminal force in lead V1 (PTFV1) to ASTRAL score for poor functional prognosis in patients with acute ischemic stroke. Methods The study was a prospective cohort study. The hospitalized ischemic stroke patients within 7 days of onset from January 2019 to December 2021 in The First Affiliated Hospital of Zhengzhou University were enrolled. The baseline characteristics were collected, the values of PTFV1 were measured, and ASTRAL scores were evaluated. The unfavorable outcome was defined as 1-year modified Rankin Scale score (mRS) >2. Logistic regression model was conducted to determine the association of PTFV 1 with unfavorable outcome. P-ASTRAL score was established by adding PTFV1 to ASTRAL score. The receiver operating characteristics (ROC) curves were plotted, and areas under the curves (AUC) were calculated to evaluate the prognostic significance. Results A total of 3 399 acute stroke patients were enrolled. The average age were (59±12) years old (range: 16-95 years), 70.3% (2 390/3 399) of patients were male, 8.8% (299/3 399) patients had an increased PTFV1 value. In comparison with patients with mRS≤2, patients with poor functional outcome were much older (t=12.40, P<0.001), had a higher proportion of male (χ2=23.85, P<0.001), had much more risk factors [diabetes mellitus (χ2=5.54, P=0.019), stroke history (χ2=56.38, P<0.001), coronary heart disease (χ2=22.72, P<0.001) ], had a higher proportion of increased PTFV1 value (χ2=229.65, P<0.001), and higher ASTRAL score (χ2=424.02, P<0.001). After adjusting confounding factors, PTFV1>5 000 μV·ms (OR=4.168, 95%CI 3.101-5.602, P<0.001) and ASTRAL score (OR=1.122, 95%CI 1.097-1.148, P<0.001) could increased the risk of 1-year poor functional outcome. TheAUC for P-ASTRAL score was higher than ASTRAL score (0.753 vs. 0.739, Z=2.317, P=0.021) . Conclusion PTFV1 was an independent risk factor of unfavorable outcome for stroke. P-ASTRAL score could improve the predictive value of poor functional outcome for ischemic stroke.
关键词
卒中/V/1导联P波终末电势/洛桑评分/预测价值/不良预后
Key words
Stroke/P-wave terminal force in lead V 1/ASTRAL score/Predictive value/Unfavorable outcome
万方数据