Brouns Raf, Sheorajpanday Rishi, Kunnen Jan, De Surgeloose Didier, De Deyn Peter Paul
Department of Neurology and Memory Clinic, ZNA Middelheim Hospital, Antwerp, Belgium.
Eur Neurol. 2009;62(1):9-15. doi: 10.1159/000215876. Epub 2009 Apr 30.
We investigated the predictive value of standard neurological evaluation, a commercially available biomarker assay and neuroimaging in the subacute phase for outcome after thrombolytic therapy in ischemic stroke.
Thirty-four consecutive ischemic stroke patients were evaluated by means of the NIH Stroke Scale (NIHSS(72)), the Triage(R) Stroke Panel (MMX(72)) and standardized infarct volumetry at 72 h after treatment with intravenous recombinant tissue plasminogen activator or intra-arterial urokinase. Outcome was assessed by the modified Rankin Scale (mRS) at 3 months after the stroke.
NIHSS(72), MMX(72) and infarct volume correlated significantly with the mRS score at month 3 and emerged as independent outcome predictors from logistic regression analysis. NIHSS(72) is the best predictor for outcome, but its accuracy increases by 9 and 6% when combined with MMX(72) and infarct volumetry, respectively. The combined use of NIHSS(72) and MMX(72) allows long-term outcome prediction with 97% accuracy, which is not further improved by infarct volumetry.
Routine clinical evaluation, bedside testing of biochemical markers by the Triage Stroke Panel and infarct volumetry on neuroimaging at 72 h after thrombolytic therapy are predictors for long-term outcome of ischemic stroke patients. Clinical assessment is the most reliable parameter for outcome prediction, but its predictive value is substantially improved when combined with the biomarker panel.
我们研究了标准神经学评估、一种市售生物标志物检测方法以及神经影像学检查在亚急性期对缺血性中风溶栓治疗后预后的预测价值。
连续34例缺血性中风患者在接受静脉重组组织型纤溶酶原激活剂或动脉内尿激酶治疗72小时后，通过美国国立卫生研究院卒中量表（NIHSS(72)）、分诊卒中小组检测（MMX(72)）和标准化梗死体积测定进行评估。中风后3个月通过改良Rankin量表（mRS）评估预后。
NIHSS(72)、MMX(72)和梗死体积与第3个月的mRS评分显著相关，并在逻辑回归分析中成为独立的预后预测指标。NIHSS(72)是预后的最佳预测指标，但分别与MMX(72)和梗死体积测定联合使用时，其准确性提高了9%和6%。联合使用NIHSS(72)和MMX(72)可实现97%准确率的长期预后预测，梗死体积测定并不能进一步提高预测准确性。
溶栓治疗72小时后的常规临床评估、分诊卒中小组对生化标志物的床旁检测以及神经影像学检查中的梗死体积测定是缺血性中风患者长期预后的预测指标。临床评估是预后预测最可靠的参数，但与生物标志物检测联合使用时其预测价值会显著提高。
