心源性脑栓塞型患者快速筛选的多因素预测模型构建
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摘要
目的构建急诊室快速筛选心源性脑栓塞(CE)型患者的多因素预测数学模型。方法对2015年6月至2016年5月期间,佛山市中医院及其附属医院急诊科收治的急性缺血性卒中患者进行前瞻性分析。参考中华医学会和美国AHA/ASA卒中指南对拟诊为卒中的患者进行诊疗。多学科专家诊断小组根据入选患者的诊疗资料和随访资料,构建快速筛选CE型患者的多因素预测数学模型。结果研究期间内,共有290例卒中患者纳入研究,平均(68.4±12.1)岁,男性达46.2%。参考TOAST分型:CE型17.9%;LAA型28.3%;SAO型42.8%,SOE和SUE型达11.0%。在校正可能的混杂因素后,B型脑钠肽(BNP)与D-二聚体(DD)是预测CE型的独立因素[BNP OR:1.04 (95%CI:1.03～1.06),P<0.01;DD OR:1.51(95%CI 1.02～2.24),P=0.04],并建立起快速筛选CE型的多因素预测数学模型。结论结合床边快速检测技术(POCT),该多因素预测数学模型可辅助用于CE型患者的快速筛选。
Objective To construct a multi-variable prediction model for rapid recognition of patients with cardioembolic(CE) stroke. Methods This multi-center study was prospectively conducted in Foshan Hospital of TCM and its affiliated hospitals. From June 2015 to May 2016, patients(≥18 yrs) with suspected acute stroke were assessed on admission by emergency physicians. Patients′ neurological outcome and final diagnosis with TOAST subtypes were confirmed by neurologists. And a multi-variable prediction model for rapid recognition of CE stroke was analyzed according to the clinical data. Results A total of 290 stroke patients met this study criteria(mean age 68.4±12.1 years; 46.2% male). The final diagnosis at discharge was 17.9% with CE, 28.3% with LAA, 42.8% with SAO, and 11.0% with SOE or SUE. After adjustment for multiple possible clinical confounders, BNP and D-dimer were significantly associated with CE [BNP OR: 1.04(95%CI 1.03,1.06), P<0.01; D-dimer OR: 1.51(95% CI 1.02, 2.24), P=0.04]. A multi-variable prediction model with B-type natriuretic peptide was established for rapid recognition of CE. Conclusion Through this prediction model, CE stroke patients would be differentiated from other TOAST subtypes.
Objective To construct a multi-variable prediction model for rapid recognition of patients with cardioembolic(CE) stroke. Methods This multi-center study was prospectively conducted in Foshan Hospital of TCM and its affiliated hospitals. From June 2015 to May 2016, patients(≥18 yrs) with suspected acute stroke were assessed on admission by emergency physicians. Patients′ neurological outcome and final diagnosis with TOAST subtypes were confirmed by neurologists. And a multi-variable prediction model for rapid recognition of CE stroke was analyzed according to the clinical data. Results A total of 290 stroke patients met this study criteria(mean age 68.4±12.1 years; 46.2% male). The final diagnosis at discharge was 17.9% with CE, 28.3% with LAA, 42.8% with SAO, and 11.0% with SOE or SUE. After adjustment for multiple possible clinical confounders, BNP and D-dimer were significantly associated with CE [BNP OR: 1.04(95%CI 1.03,1.06), P<0.01; D-dimer OR: 1.51(95% CI 1.02, 2.24), P=0.04]. A multi-variable prediction model with B-type natriuretic peptide was established for rapid recognition of CE. Conclusion Through this prediction model, CE stroke patients would be differentiated from other TOAST subtypes.
引文
[1] O′Carroll CB,Barrett KM.Cardioembolic Stroke[J].Continuum (Minneap Minn),2017,23(1,Cerebrovascular Disease):111-132.
[2] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性卒中诊治指南2014[J].中华神经科杂志,2015,48(4),246-257.
[3] Yang HL,Lin YP,Long Y,et al.Predicting cardioembolic stroke with the B-type natriuretic peptide test:a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2014,23(7):1882-1889.
[4] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[5] PJauch EC,Cucchiara B,Adeoye O,et al.Part 11:adult stroke:2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2010,122(18 Suppl 3):S818-S828.
[6] Wu Z,Zhao M,He M,et al.Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED[J].Am J Emerg Med,2015,33(4):521-526.
[7] Llombart V,Garcia-Berrocoso T,Bustamante A,et al.Cardioembolic stroke diagnosis using blood biomarkers[J].Curr Cardiol Rev,2013,9(4):340-352.
[8] Montaner J,Perea-Gainza M,Delgado P,et al.Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers[J].Stroke,2008,39(8):2280-2287.
[9] Komori T,Eguchi K,Tomizawa H,et al.Factors associated with incident ischemic stroke in hospitalized heart failure patients:a pilot study[J].Hypertens Res,2008,31(2):289-294.
[10] M?kikallio AM,M?kikallio TH,Korpelainen JT,et al.Natriuretic peptides and mortality after stroke[J].Stroke,2005,36(5):101610-20.
[11] García-Berrocoso T,Giralt D,Bustamante A,et al.B-type natriuretic peptides and mortality after stroke:a systematic review and meta-analysis[J].Neurology,2013,81(23):1976-1985.
[12] Lip GY,Gibbs CR.Does heart failure confer a hypercoagulable state?Virchow′s triad revisited[J].J Am Coll Cardiol,1999,33(5):1424-1426.
[13] 吴智鑫,蒋龙元.B型脑钠肽对急性缺血性卒中患者TOAST病因学分型的应用进展[J].岭南急诊医学杂志,2012,17(5):399-401.
[14] Shibazaki K,Kimura K,Fujii S,et al.Brain natriuretic peptide levels as a predictor for new atrial fibrillation during hospitalization in patients with acute ischemic stroke[J].Am J Cardiol,2012,109(9):1303-1307.
[15] 张真路.BNP和NT-proBNP结果判断一定要结合临床背景[J].中华检验医学杂志,2012,35(10):874-877.
[16] Zhixin W,Lianhong Y,Wei H,et al.The value of the use of plasma B-type natriuretic peptide among acute ischemic stroke patients in a Chinese emergency department[J].Clin Neurol Neurosurg,2013,115(9):1671-1676.
[17] Wu Z,Yang L,Guo Q,et al.Experiences and the use of BNP POCT platform on suspected ischemic stroke patients in the emergency department setting[J].Clin Neurol Neurosurg,2014,123:199-200.
[18] He M,Wu Z,Li Y,et al.A new algorithm of suspected stroke patient management with brain natriuretic peptide/N-terminal pro-brain natriuretic peptide point of care testing platform in the emergency department[J].Ann Indian Acad Neurol,2017,20(1):81-82.
[19] 黄尚明,吴智鑫,何明丰,等.B型脑钠肽即时检测技术对急性缺血性卒中患者TOAST分型筛选价值的研究[J].中国医药科学,2015,5(8):7-10.
[20] 吴智鑫,李莹莹,何明丰,等.B型脑钠肽联合D-二聚体对心源性栓塞型脑卒中患者的快速筛选价值探讨[J].实用医学杂志,2018,34(1):44-48.
[21] 吴智鑫.BNP即时检测技术对心源性栓塞型脑卒中患者快速筛选价值的多中心临床研究[D].广州:南方医科大学,2017.
[2] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性卒中诊治指南2014[J].中华神经科杂志,2015,48(4),246-257.
[3] Yang HL,Lin YP,Long Y,et al.Predicting cardioembolic stroke with the B-type natriuretic peptide test:a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2014,23(7):1882-1889.
[4] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[5] PJauch EC,Cucchiara B,Adeoye O,et al.Part 11:adult stroke:2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2010,122(18 Suppl 3):S818-S828.
[6] Wu Z,Zhao M,He M,et al.Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED[J].Am J Emerg Med,2015,33(4):521-526.
[7] Llombart V,Garcia-Berrocoso T,Bustamante A,et al.Cardioembolic stroke diagnosis using blood biomarkers[J].Curr Cardiol Rev,2013,9(4):340-352.
[8] Montaner J,Perea-Gainza M,Delgado P,et al.Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers[J].Stroke,2008,39(8):2280-2287.
[9] Komori T,Eguchi K,Tomizawa H,et al.Factors associated with incident ischemic stroke in hospitalized heart failure patients:a pilot study[J].Hypertens Res,2008,31(2):289-294.
[10] M?kikallio AM,M?kikallio TH,Korpelainen JT,et al.Natriuretic peptides and mortality after stroke[J].Stroke,2005,36(5):101610-20.
[11] García-Berrocoso T,Giralt D,Bustamante A,et al.B-type natriuretic peptides and mortality after stroke:a systematic review and meta-analysis[J].Neurology,2013,81(23):1976-1985.
[12] Lip GY,Gibbs CR.Does heart failure confer a hypercoagulable state?Virchow′s triad revisited[J].J Am Coll Cardiol,1999,33(5):1424-1426.
[13] 吴智鑫,蒋龙元.B型脑钠肽对急性缺血性卒中患者TOAST病因学分型的应用进展[J].岭南急诊医学杂志,2012,17(5):399-401.
[14] Shibazaki K,Kimura K,Fujii S,et al.Brain natriuretic peptide levels as a predictor for new atrial fibrillation during hospitalization in patients with acute ischemic stroke[J].Am J Cardiol,2012,109(9):1303-1307.
[15] 张真路.BNP和NT-proBNP结果判断一定要结合临床背景[J].中华检验医学杂志,2012,35(10):874-877.
[16] Zhixin W,Lianhong Y,Wei H,et al.The value of the use of plasma B-type natriuretic peptide among acute ischemic stroke patients in a Chinese emergency department[J].Clin Neurol Neurosurg,2013,115(9):1671-1676.
[17] Wu Z,Yang L,Guo Q,et al.Experiences and the use of BNP POCT platform on suspected ischemic stroke patients in the emergency department setting[J].Clin Neurol Neurosurg,2014,123:199-200.
[18] He M,Wu Z,Li Y,et al.A new algorithm of suspected stroke patient management with brain natriuretic peptide/N-terminal pro-brain natriuretic peptide point of care testing platform in the emergency department[J].Ann Indian Acad Neurol,2017,20(1):81-82.
[19] 黄尚明,吴智鑫,何明丰,等.B型脑钠肽即时检测技术对急性缺血性卒中患者TOAST分型筛选价值的研究[J].中国医药科学,2015,5(8):7-10.
[20] 吴智鑫,李莹莹,何明丰,等.B型脑钠肽联合D-二聚体对心源性栓塞型脑卒中患者的快速筛选价值探讨[J].实用医学杂志,2018,34(1):44-48.
[21] 吴智鑫.BNP即时检测技术对心源性栓塞型脑卒中患者快速筛选价值的多中心临床研究[D].广州:南方医科大学,2017.