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目的 探讨多时间点美国国立卫生研究院脑卒中量表(NIHSS)评分对老年大面积急性缺血性脑卒中患者远期良好功能结局的预测价值，并比较保守治疗与血管内治疗(EVT)的结局差异。方法 连续纳入100例老年大面积急性缺血性脑卒中患者，随机分为保守治疗组与EVT组各50例。以60～120 d改良Rankin量表(mRS)0～2分为良好功能结局，收集多时间点NIHSS及基线Alberta脑卒中早期CT评分(ASPECTS)、mRS评分。采用受试者工作特征(ROC)曲线分析各时间点NIHSS的预测效能，并构建多因素Logistic回归模型评估独立预测因素。结果 EVT组良好功能结局率显著高于保守治疗组，mRS整体分布明显优于保守治疗组(P<0.001),两组死亡率差异无统计学意义(P>0.05)。NIHSS预测效能随时间延长逐步提升(入院AUC=0.71,12 h AUC=0.90,24～72 h AUC=0.94)。24～72 h NIHSS评分以≤7分为截断值时，特异度0.90,阳性似然比(LR+)=8.11。NIHSS基线至24～72 h改善水平(ΔNIHSS)≥4分呈高特异度(0.984)、高阳性预测值(PPV,0.947)特征。多因素Logistic回归显示，24～72 h NIHSS评分为独立预测因子(P<0.001),加入后模型拟合显著改善(P<0.001)。结论 EVT可显著改善老年大面积急性缺血性脑卒中患者远期功能结局。24～72 h NIHSS评分是远期良好结局的强效早期预测指标，截断值≤7分兼顾敏感度与特异度，校正混杂因素后仍具显著增量预测价值。ΔNIHSS≥4分适合作为神经功能早期改善的高特异度确认工具。上述结果为将24～72 h NIHSS评分纳入老年大面积脑卒中早期预警路径、实现老年患者精准预后分层与个体化治疗决策提供了循证依据。
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基本信息:
中图分类号:R743.3
引用信息:
[1]王贺,张逊娟.NIHSS早期评分对老年大面积急性缺血性脑卒中患者功能结局的预测价值[J].中国老年学杂志,2026,46(15):2689-2694.
基金信息:
吉林省自然科学基金(YDZJ202401024ZYTS)
2026-08-10
2026-08-10