Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset.
Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset.
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DOI：
10.1161/strokeaha.111.636928
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发表时间：
2012-06
期刊：
影响因子：
8.3
通讯作者：
Altman H
中科院分区：
文献类型：
--
作者：
Saver JL;Altman H
早期神经功能缺失的严重程度是急性缺血性卒中最终功能结局的最重要决定因素。然而，缺陷的严重程度在发病后的头几个小时和几天内经常发生变化。对参加两项NINDS TPA试验的对照组患者进行分析。分别于发病后1~3h、3~5h、24小时、7~10天、90天采用美国国立卫生研究院卒中评定量表(NIHSS)进行神经功能评分。在90天时使用改良的Rankin量表(MRS)评估最终的全球残疾结果。在312例患者中，在整个90d观察期内，NIHSS的中位神经功能缺损程度得到改善，从1-3h的15(IQR 9.5-20)到24小时的12(6-19)，到90d的7(2-19)。在1-3小时至24小时内，自发改善的患者多于恶化的患者，39.1%对17.6%(p<；0.001)。随着时间的推移，与个体最终MRS全球残疾等级相关的NIHSS评分向较低的值转变，例如，最终MRS为2的患者在1-3小时的NIHSS评分的中位数为12，3-5小时的NIHSS评分的中位数为10，24小时的NIHSS评分的中位数为9，90天的NIHSS评分的中位数为3。NIHSS和最终MRS的相关系数随着时间的推移而增加，从1-3h的0.51到24d的0.72，到90d的0.87。在发病后的头24小时内，5名急性缺血性中风患者中有2名出现自发改善。与全球残疾个人排名相关的NIHSS得分随着时间的推移而下降。神经功能缺失的严重程度越来越多地预测最终的残疾结果，在1-3h占四分之一，在24小时占一半，在90d占四分之三。
Early neurologic deficit severity is the most important determinant of final functional outcome in acute ischemic stroke. However, deficit severity frequently changes during the first hours and days post-onset. Analysis of control group patients enrolled in the two NINDS TPA trials. Neurologic deficit severity was measured serially using the NIH Stroke Scale (NIHSS) at 1-3h post onset, 3-5h, 24h, 7-10 days, and 90 days. Final global disability outcome was assessed at 90 days using the modified Rankin Scale (mRS). Among the 312 patients, median neurologic deficit severity on the NIHSS improved throughout the 90d observation period, from 15 (IQR 9.5-20) at 1-3h through 12 (6-19) at 24h to 7 (2-19) at 90d. Between 1-3h to 24h, more patients spontaneously improved than worsened, 39.1% vs 17.6% (p<0.001). NIHSS scores associated with individual final mRS global disability ranks shifted to lower values over time, e.g. patients with a final mRS of 2 had the following median NIHSS scores of 12 at 1-3h, 10 at 3-5h, 9 at 24h, and 3 at 90d. Correlation coefficients between NIHSS and the final mRS increased over time, from 0.51 at 1-3h through 0.72 at 24h to 0.87 at 90d. During the first 24 hours after onset, spontaneous improvement occurs in 2 of 5 acute ischemic stroke patients. The NIHSS scores associated with individual global disability ranks shift lower over time. Neurologic deficit severity increasingly predicts final disability outcome, accounting for one quarter of the variance at 1-3h, one half at 24h, and three quarters at 90d.