Bruno Askiel, Saha Chandan, Williams Linda S
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Stroke Cerebrovasc Dis. 2009 Jan;18(1):56-9. doi: 10.1016/j.jstrokecerebrovasdis.2008.09.002.
A single optimal outcome measure in acute stroke has not been established. Changes in neurologic deficits might be useful outcome measures in acute stroke because they can measure within-subject changes on the entire spectrum of the scales starting at baseline.
We tested the ability of percent National Institutes of Health Stroke Scale (NIHSS) score change (baseline-3 months) to predict the traditional functional outcomes in acute stroke (modified Rankin Scale [mRS], Barthel Index, Glasgow Outcome Scale, final NIHSS score). We analyzed data sets from two acute stroke clinical trials involving 44 clinical research centers throughout the United States and 1899 randomized patients.
The percent NIHSS score change predicted functional outcomes very well, all areas under the curve of 0.90 or greater with all P values less than .001 in receiver operating characteristic analysis. In the National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator (rt-PA) Acute Stroke Trial, benefit from rt-PA was confirmed by a greater improvement on the NIHSS score than with placebo (67% v 50%, P < .002). In moderate stroke severity (baseline NIHSS score 7-15) an improvement of at least 55% was the best predictor of functional independence at 3 months (mRS <or= 2).
This novel approach to the NIHSS score as an outcome measure in acute stroke appears to be an additional useful analytic and communication tool.
急性卒中尚未确立单一的最佳疗效指标。神经功能缺损的变化可能是急性卒中有用的疗效指标，因为它们可以测量从基线开始整个量表范围内的个体内部变化。
我们测试了国立卫生研究院卒中量表（NIHSS）评分变化百分比（基线至3个月）预测急性卒中传统功能结局（改良Rankin量表[mRS]、Barthel指数、格拉斯哥结局量表、最终NIHSS评分）的能力。我们分析了来自两项急性卒中临床试验的数据集，这两项试验涉及美国各地的44个临床研究中心和1899名随机分组的患者。
NIHSS评分变化百分比对功能结局的预测效果非常好，在接受者操作特征分析中，所有曲线下面积均为0.90或更高，所有P值均小于0.001。在国立神经疾病和中风研究所重组组织型纤溶酶原激活剂（rt-PA）急性卒中试验中，rt-PA组的NIHSS评分改善程度高于安慰剂组（67%对50%，P<0.002），从而证实了rt-PA的益处。在中度卒中严重程度（基线NIHSS评分为7 - 15）时，至少55%的改善是3个月时功能独立（mRS≤2）的最佳预测指标。
这种将NIHSS评分作为急性卒中疗效指标的新方法似乎是一种额外有用的分析和交流工具。
