Stockholm CT评分联合事件相关电位评估颅脑外伤慢性意识障碍患者预后的临床研究

关键词：慢性意识障碍  颅脑损伤  Stockholm CT  事件相关电位

Keywords:prolonged disorders of consciousness  traumatic brain injury  Stockholm CT  event-related potentials

摘要：

      摘要 目的：探讨Stockholm CT评分联合事件相关电位在颅脑外伤慢性意识障碍（prolonged disorders of consciousness，pDoC）患者中的预后判断价值。 方法：回顾性研究68例颅脑外伤pDoC患者，记录患者的一般资料、修订昏迷恢复量表（coma recovery scale - revised，CRS-R）评分、Stockholm CT评分和事件相关电位（MMN和P300）结果。以患者病程满6个月、脱离最小意识状态或者死亡为研究终点，根据患者意识是否恢复分为清醒组和未清醒组，分析CRS-R评分、Stockholm CT评分、事件相关电位与预后的关系。筛选出有意义指标，并采用logistic回归分析法，建立回归模型，绘制ROC曲线，评估其预后预测价值。 结果：两组患者CRS-R评分、Stockholm CT评分、MMN波幅、P300潜伏期与波幅，差异均有显著性意义（P＜0.05）。但是，仅Stockholm CT评分和MMN波幅被纳入logistic回归模型。绘制ROC曲线发现，Stockholm CT评分、MMN波幅以及两项联合的AUC值均较高（P＜0.01），且两项联合的AUC值（91.3%）和约登指数（72.5%）均最高。 结论：Stockholm CT评分、MMN波幅均与颅脑外伤pDoC患者的预后相关，且两项联合对颅脑外伤pDoC患者的预后有较高的预测价值。

Abstract:

      Abstract Objective： To evaluate the prognostic value of Stockholm CT score combined with event-related potentials in patients with prolonged disorders of consciousness （pDoC） after traumatic brain injury. Method： A retrospective study was conducted on 68 pDoC patients with traumatic brain injury， recording their general information， revised coma recovery scale revised （CRS-R） scores， Stockholm CT scores， and event-related potentials （MMN and P300）. The primary endpoint of the study was defined as 6 months post-surgery， leaving minimal conscious state， or death. Patients were divided into conscious group and unconscious groups based on their conscious state. The relationship between CRS-R score， Stockholm CT score， event-related potential， and prognosis was analyzed. Select meaningful indicators and use logistic regression analysis to establish a regression model. Draw ROC curves， and evaluate their prognostic predictive value. Result： The differences in CRS-R score， Stockholm CT score， MMN amplitude， P300 latency and amplitude between conscious group and unconscious groups were statistically significant （P＜0.05）. However， only the Stockholm CT score and MMN amplitude were included in the logistic regression model. By plotting the ROC curve， it was found that the AUC value of Stockholm CT score， MMN amplitude， and the combination of these two items were all high （P＜0.01）. Especially， the combination of Stockholm CT score and MMN amplitude showed the highest AUC value （91.3%） and Youden’s index （72.5%）. Conclusion： Stockholm CT score and MMN amplitude are both associated with the prognosis of pDoC patients with traumatic brain injury， and the combination of these two items has a high predictive value for the prognosis of pDoC patients with traumatic brain injury.