中文摘要：

目的 探讨基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分对大血管闭塞的预测价值.方法 利用“南京卒中注册系统”,回顾性分析发病24 h内入院且需行急诊数字减影血管造影（digital subtraction angiography,DSA）检查或介入治疗的急性缺血性卒中患者.在患者就诊即刻进行NIHSS评分,根据DSA结果分为大血管闭塞组与非大血管闭塞组.大血管闭塞定义为颈内动脉、大脑中动脉MI/M2段、椎动脉V4段或基底动脉存在血管闭塞,非大血管闭塞定义为未见血管闭塞或血管闭塞存在于大脑中动脉M3/M4段、大脑前动脉或大脑后动脉.利用受试者工作特征（receiver operator characteristic,ROC）曲线和曲线下面积（c统计量）评估NIHSS评分对大血管闭塞的预测能力,计算灵敏度、特异度、阳性预测值及阴性预测值.采用多变量logistic回归分析筛选出判别大血管闭塞的独立危险因素.结果 共纳入100例急性缺血性卒中患者,其中前循环卒中63例,后循环卒中37例.NIHSS评分预测全部患者大血管闭塞的ROC曲线下面积（c统计量）为0.734[95％可信区间（confidence interval,CI）0.621 ～0.848],预测前循环与后循环大血管闭塞分别为0.817（95％ CI0.699 ～0.936）和0.683（95％ CI 0.505 ～0.861）.NIHSS评分判断全部患者大血管闭塞的最佳截断值为13分（灵敏度为0.776,特异度为0.697,阳性预测值为0.839,阴性预测值为0.605）.多变量logistic回归分析显示,“意识水平提问”[优势比（odds ratio,OR）4.673,95％ CI 1.853 ～ 11.786;P=0.001]和“凝视”（OR 3.514,95％ CI 1.271 ～9.716; P=0.015）是大血管闭塞的独立危险因素.结论 基线NIHSS评分对急性缺血性卒中患者的大血管闭塞具有一定的预测价值,尤其对于前循环大血管闭塞的预测价值较高.在NIHSS评分项目中,“意识水平提问”和“凝视”是判别大血管闭塞的独立危险因素.

英文摘要：

Objective To investigate the predictive value of the National Institutes of Health Stroke Scale （NIHSS） score for large vessel occlusion.Methods Using Nanjing Stroke Registry Program,the patients with acute ischemic stroke admitted within 24 hours after onset and needed emergency digital subtraction angiography （DSA） or interventional therapy were analyzed retrospectively.The NIHSS score was performed at the immediate treatment of patients.The patients were divided into either a large vessel occlusion group or a non-large vessel occlusion group according to the findings of digital subtraction angiography （DSA）.Large vessel occlusion was defined as the occlusion of internal carotid artery,M1/M2 segment of the middle cerebral artery,V4 segment of the vertebral artery or basilar artery.Non-large vessel occlusion was defined as no vascular occlusion or vascular occlusion at the M3/M4 segment of the middle cerebral artery,anterior cerebral artery or posterior cerebral artery was observed.Receiver operating characteristic （ROC） curve and the area under the curve （c statistics） were used to evaluate the NIHSS score for the predictive capability of large vessel occlusion.The sensitivity,specificity,positive predictive value,and negative predictive value were calculated.Multivariate logistic regression analysis was used to screen the independent risk factors for identifying large vessel occlusion.Results A total 100 patients with acute ischemic stroke were enrolled,including 63 with anterior circulation stroke and 37 with posterior circulation stroke.The NIHSS score for predicting ROC area under the curve （c statistics） of all patients with large vessel occlusion was 0.734 （95% confidence interval [CI] 0.621-0.848）,the predictions of anterior circulation and posterior circulation large vessel occlusion were 0.817 （95% CI 0.699-0.936） and 0.683 （95% CI 0.505-0.861）.The NIHSS score identifying the best cutoff value of all patients with large vessel occlusion was 13 （sensitivity 0.776,sp