不同评分系统对颅脑外伤患者近期预后预测效能的对比分析

苏观; 陈延茹; 杨涛; 梁城英; 张若

doi:10.16766/j.cnki.issn.1674-4152.001721

不同评分系统对颅脑外伤患者近期预后预测效能的对比分析

doi: 10.16766/j.cnki.issn.1674-4152.001721

苏观¹,
陈延茹^1, ,,
杨涛¹,
梁城英²,
张若³

1.
温州医科大学附属第二医院DSA中心，浙江温州 325000
2.
温州医科大学附属第二医院成人急诊科，浙江温州 325000
3.
温州医科大学附属第二医院胃肠外科，浙江温州 325000

基金项目:

浙江省自然科学基金项目 LY15H090016

温州市科技计划项目 Y20160175

详细信息

通讯作者:
陈延茹，E-mail: cyr228@163.com

中图分类号: R651.15
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- 被引次数: 0
出版历程
- 收稿日期: 2020-02-16
- 网络出版日期: 2022-02-19

Comparative analysis of four scoring systems in predicting the short-term prognosis of patients with traumatic brain injury

1.
Department of DSA Center, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨4种常用的评分方式对颅脑外伤(TBI)患者病情预后评估分效能。方法选择2017年1月—2018年6月温州医科大学附属第二医院接诊的TBI患者149例，按照患者入院后28 d时预后将所有患者分为预后良好和预后不良2种情况。分析2组患者入院时一般资料并根据格拉斯哥昏迷指数(GCS)、急性生理学及慢性健康状况评分(APACHEⅡ)、改良早期预警评分(MEWS)和分流早期预警评分(TEWS)对患者入院时状态进行评分，而后采用logistic回归分析判断影响患者预后的因素，并使用ROC曲线评价4种评分对患者预后的预测效能。结果患者出院时预后不良例数为42例，预后不良率为28.18%。预后良好患者颅内出血率、GCS、APACHEⅡ、MEWS、TEWS均显著低于预后不良患者，伤情显著优于预后不良患者(均P < 0.05)。APACHEⅡ、MEWS及TEWS为影响患者预后的独立危险因素。ROC分析结果显示，APACHEⅡ及TEWS对TBI患者预后的AUC显著大于MEWS(均P < 0.05)，APACHEⅡ及TEWS对TBI患者预后的AUC比较差异无统计学意义(P>0.05)。结论 TWES与APACHEⅡ对于TBI患者预后均有较好的预测效能，但TWES预测阳性可信度较好，可以将之运用于TBI患者入院时评估中。
- 预警评分 /
- 颅脑外伤 /
- 预后 /
- 预测性分析
Abstract: Objective To investigate the efficacy of four scoring methods in evaluating the prognosis of patients with traumatic brain injury (TBI). Methods A total of 149 patients with TBI who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to June 2018 were selected. According to the prognosis at 28 days after admission, all patients were divided into two types: good prognosis and poor prognosis. The general data of the two groups of patients at admission was analyzed and the patients' admission status was scored based on the Glasgow Coma Index (GCS), Acute Physiology and Chronic Health Status Score (APACHEⅡ), Modified Early Warning Score (MEWS), and Triage Early Warning Score (TEWS). Then logistic regression analysis was used to determine the factors affecting the prognosis of the patients, and the ROC curve was used to evaluate the predictive power of the four scores on the prognosis of the patients. Results The number of patients with poor prognosis at the time of discharge was 42, and the poor prognosis rate was 28.18%. The intracranial hemorrhage rate, GCS, APACHEⅡ, MEWS, and TEWS of patients with good prognosis were significantly lower than those with poor prognosis, and the injuries were significantly better than those with poor prognosis (all P < 0.05). The APACHEⅡ, MEWS and TEWS were the independent risk factors that affect the prognosis of patients (all P < 0.05). The results of ROC analysis showed that the prognosis of APACHEⅡ and TEWS for TBI patients were significantly greater than that of MEWS (both P < 0.05), and the prognosis of APACHEⅡ and TEWS for TBI patients were not significantly different (P>0.05). Conclusion Both TWES and APACHEⅡ have better predictive power for the prognosis of TBI patients, but the positive predictive reliability of TWES is good, and they can be used in TBI patients' admission evaluation.
- Warning score /
- Traumatic brain injury /
- Prognosis /
- Predictive analysis

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图 1 MEWS及TEWS对TBI患者预后预测的ROC曲线图

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表 1 2组TBI患者一般资料中影响预后情况的单因素分析

自变量	例数	年龄(岁)	性别		BMI		吸烟史[例(%)]	颅内出血[例(%)]	GCS(分)	APACHEⅡ(分)	MEWS(分)		TEWS(分)
自变量	例数	年龄(岁)	男性	女性	BMI		吸烟史[例(%)]	颅内出血[例(%)]	GCS(分)	APACHEⅡ(分)	MEWS(分)		TEWS(分)
预后良好组	107	38.14±9.51	67	40	22.14±2.94		59(55.14)	11(10.28)	7.32±1.71	15.82±4.35	1.64±0.51		3.79±1.03
预后不良组	42	41.55±10.12	24	18	22.88±3.01		27(64.29)	17(40.48)	8.98±1.99	27.05±5.13	3.04±1.09		6.91±1.79
统计量		-1.881^a	0.380^b	-1.359^a	1.033^b		18.021^b	4.731^a	-13.463^a	-11.190^a		-13.304^a
P值		0.063	0.537	0.178	0.309		< 0.001	< 0.001	< 0.001	< 0.001		< 0.001

自变量	例数	损伤至入院时间(h)	基础疾病[例(%)]			伤情[例(%)]				损伤原因[例(%)]
自变量	例数	损伤至入院时间(h)	高血压	糖尿病		轻	中	重		交通事故	坠落伤	重物砸伤	其他
预后良好组	107	5.63±2.13	34(31.78)	21(19.63)		29(27.10)	59(55.14)	19(17.76)		67(62.62)	20(18.69)	13(12.15)	7(6.54)
预后不良组	42	6.42±3.09	17(40.48)	12(28.57)		5(11.90)	12(28.57)	25(59.52)		20(47.62)	11(26.19)	7(16.67)	4(9.52)
统计量		-1.708^a	1.014^b	1.399^b		19.407^c				2.798^b
P值		0.076	0.313	0.236		< 0.001				0.423
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组TBI患者实验室指标中影响预后情况的单因素分析(x±s)

组别	例数	AST(U/L)	ALT(U/L)	Cr(mmol/L)	BUN(mmol/L)	TC(mmol/L)	WBC(×10⁹/L)	PLT(×10⁹/L)
预后良好组	107	56.73±18.34	40.67±13.45	99.25±21.47	15.07±4.23	2.44±0.65	9.79±1.42	157.69±34.51
预后不良组	42	61.21±21.13	45.34±19.12	93.74±19.51	16.54±5.02	2.51±0.84	10.02±1.97	147.54±30.17
t值		-1.207	-1.448	1.506	-1.678	-0.458	-0.689	1.772
P值		0.231	0.152	0.135	0.098	0.628	0.493	0.079

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表 3 影响患者预后的logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
颅内出血	1.745	2.629	3.259	0.071	5.725	-0.097~6.502
GCS	0.256	0.586	0.191	0.662	1.291	0.147~4.073
APACHEⅡ	1.453	0.249	3.946	0.026	4.275	2.371~7.982
MEWS	1.097	1.799	3.539	0.041	2.955	1.043~9.578
TEWS	1.082	2.595	3.933	0.027	2.951	1.641~6.584
伤情
轻度	-4.547	4.812	0.893	0.345	0.011	0.000~132.180
中度	-2.707	2.196	1.520	0.218	0.067	0.001~4.935
常数	-25.045	17.262	2.105		0.147	-25.045~0.000

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表 4 4种评分方式对患者预后的预测价值分析

评分方式	截点值	SE	P值	AUC	95% CI
GCS	8	0.051	< 0.001	0.722	0.622~0.823
MEWS	2	0.028	< 0.001	0.892^a	0.873~0.962
APACHEⅡ	21	0.006	< 0.001	0.987^ab	0.975~0.999
TEWS	5	0.004	< 0.001	0.993^ab	0.986~1.000
注：与GCS比较，^aP < 0.05；与MEWS比较，^bP < 0.05。

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表 5 4种评分方式灵敏度、特异度、阳性预测及阴性预测值情况(%)

评分方式	灵敏度	特异度	阳性预测值	阴性预测值
GCS	64.29	78.51	54.00	84.85
MEWS	85.71	90.65	78.26	94.17
APACHEⅡ	97.61	88.78	77.36	98.95
TEWS	95.23	96.26	90.90	98.90

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