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Neurology:改良 rankin 量表与脑卒中后上肢无力患者恢复表型的关系

2022-04-03 Naomi MedSci原创

精确评估预后对于卒中试验和临床护理至关重要; 研究证实mRS大致与特定领域的预后有关,但没有准确区分损害和功能差异,也没有充分捕捉跨损害的有意义的临床变化、ADL状态和机动性,具体表型具体应用格外重要

精确评估预后对于卒中试验和临床护理至关重要;然而,有不同的方法来衡量卒中后的恢复情况。全面的方法捕获一般功能和残疾,而特定模式方法则提供有关特定神经系统(例如,运动、语言、认知)行为输出的详细信息。卒中临床试验最常使用改良 Rankin 量表 (mRS) 作为主要终点。 mRS 量表管理高效、实用、可靠,涵盖了卒中后所有临床相关结果,可覆盖水平从无缺陷到死亡不等。虽然 mRS 被广泛接受为卒中试验中的金标准和有意义的终点,但它也因其反应受限、缺乏粒度和检测有意义变化的能力不一致而受到挑战。

序数 mRS 分级并不均等且在某种程度上是任意间隔的——这使得在解释每个水平之间的残疾差异可能具有挑战性。在检查卒中后的长期恢复时,这些弱点变得更加明显。因为在急性卒中期间住院期间测量的 mRS 水平的准确性值得怀疑,mRS 在检测卒中后头几个月的试验变化方面的效用有限。mRS 是卒中后有价值的结果测量;然而,了解使用 mRS 测量卒中结果的局限性是确定其在卒中试验中最有效和最适当的用途的关键。

上肢 (UE) 缺陷是最常见的残疾来源,也是影响卒中后整体生活质量和主观幸福感的一个因素。为进一步准确了解 mRS 在对卒中结果进行分类时测量的内容。近日有研究人员检查了缺血性卒中后 90 天上肢(UE)无力患者样本中 mRS 水平的损伤和功能差异。研究假设 mRS 将与卒中患者常用的损伤和功能结果测量高度相关,但相邻的 mRS 水平不会在统计学上捕捉到损伤或功能的不同表型。

研究特别旨在 (1) 确定 mRS 水平是否能区分损伤和功能的不同详细表型;(2) 将 mRS 结果与一组 UE 患者从卒中恢复的急性到亚急性阶段的损伤和功能的有意义变化进行比较。

方法:对缺血性卒中后上肢无力的患者在卒中后第1周和90天进行一系列功能损害和功能测定。与90天 mRS 评分相关的损伤和功能结果进行检查。临床意义的变化,运动障碍,日常生活活动能力,和流动性检查,与90天mRS。

结果:

  • 在这组73名卒中患者中,损伤和功能结果与90天 mRS评分相关,但在个别mRS水平内表现出实质性的变异性: 在mRS第2级内,上肢损伤范围从近似偏瘫(上肢 fugl-meyer 8)到无损伤(上肢 fugl-meyer 66)。
  • 总的来说,在损伤和功能结果方面,相邻两级之间没有什么差别。虽然第3和第4级的部分结果有显著差异(9孔钉、腿部运动、步速、上下计时、国立卫生研究院卒中量表和 barthel 指数) ,但第1和第2级的结果没有差异。
  • Fugl-meyer 和握力在任何相邻的mRS间都没有差异。
  • 相当数量的患者在卒中后的头90天内经历了有意义的损伤和功能改变,但没有达到良好的mRS结果(mRS ≤2)。

结论:

脑卒中试验证实脑卒中的确切价值后,mRS大致与特定领域的预后有关,但它没有准确地区分损害和功能的差异,也没有充分捕捉跨损害的有意义的临床变化,ADL状态和机动性。这些发现强调了在未来的卒中试验中与mRS一起合并详细表型测量的潜在效用。

文献来源:Erler KS, Wu R, DiCarlo JA, et al. Association of Modified Rankin Scale With Recovery Phenotypes in Patients With Upper Extremity Weakness After Stroke [published online ahead of print, 2022 Mar 11]. Neurology. 2022;10.1212/WNL.0000000000200154. doi:10.1212/WNL.0000000000200154

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    2023-01-03 yinhl1978
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    2022-04-03 卋傑

    学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2030005, encodeId=4f44203000579, content=<a href='/topic/show?id=d136200540f' target=_blank style='color:#2F92EE;'>#上肢无力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20054, encryptionId=d136200540f, topicName=上肢无力)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 17 07:54:33 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671469, encodeId=37cb16e146928, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Thu Nov 17 17:54:33 CST 2022, time=2022-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001775, encodeId=2eac2001e75af, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jan 03 10:54:33 CST 2023, time=2023-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208363, encodeId=8e09120836379, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epvFx9iafz1P5f3W97Kr4hfiaGmfv5GyDzbBGOUZYrwNc7o54MB8rxyajibn9gCUpjhvfBjicGvric3eNA/132, createdBy=0daf5232405, createdName=卋傑, createdTime=Sun Apr 03 14:23:39 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208342, encodeId=392712083421e, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=42b38096393, createdName=ms2000000159610293, createdTime=Sun Apr 03 12:02:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208285, encodeId=b499120828506, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78216166207, createdName=ms3000000876072209, createdTime=Sun Apr 03 07:46:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535331, encodeId=a63c15353317a, content=<a href='/topic/show?id=099f9020145' target=_blank style='color:#2F92EE;'>#表型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90201, encryptionId=099f9020145, topicName=表型)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b6412593156, createdName=tastas, createdTime=Mon Mar 28 07:54:33 CST 2022, time=2022-03-28, status=1, ipAttribution=)]
    2022-04-03 ms2000000159610293

    学到了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2030005, encodeId=4f44203000579, content=<a href='/topic/show?id=d136200540f' target=_blank style='color:#2F92EE;'>#上肢无力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20054, encryptionId=d136200540f, topicName=上肢无力)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 17 07:54:33 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671469, encodeId=37cb16e146928, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Thu Nov 17 17:54:33 CST 2022, time=2022-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001775, encodeId=2eac2001e75af, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jan 03 10:54:33 CST 2023, time=2023-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208363, encodeId=8e09120836379, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epvFx9iafz1P5f3W97Kr4hfiaGmfv5GyDzbBGOUZYrwNc7o54MB8rxyajibn9gCUpjhvfBjicGvric3eNA/132, createdBy=0daf5232405, createdName=卋傑, createdTime=Sun Apr 03 14:23:39 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208342, encodeId=392712083421e, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=42b38096393, createdName=ms2000000159610293, createdTime=Sun Apr 03 12:02:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208285, encodeId=b499120828506, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78216166207, createdName=ms3000000876072209, createdTime=Sun Apr 03 07:46:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535331, encodeId=a63c15353317a, content=<a href='/topic/show?id=099f9020145' target=_blank style='color:#2F92EE;'>#表型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90201, encryptionId=099f9020145, topicName=表型)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b6412593156, createdName=tastas, createdTime=Mon Mar 28 07:54:33 CST 2022, time=2022-03-28, status=1, ipAttribution=)]
    2022-04-03 ms3000000876072209

    学习了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2030005, encodeId=4f44203000579, content=<a href='/topic/show?id=d136200540f' target=_blank style='color:#2F92EE;'>#上肢无力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20054, encryptionId=d136200540f, topicName=上肢无力)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 17 07:54:33 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1671469, encodeId=37cb16e146928, content=<a href='/topic/show?id=9f4e360191a' target=_blank style='color:#2F92EE;'>#卒中后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36019, encryptionId=9f4e360191a, topicName=卒中后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff7426824786, createdName=waiwai3039, createdTime=Thu Nov 17 17:54:33 CST 2022, time=2022-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2001775, encodeId=2eac2001e75af, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jan 03 10:54:33 CST 2023, time=2023-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208363, encodeId=8e09120836379, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epvFx9iafz1P5f3W97Kr4hfiaGmfv5GyDzbBGOUZYrwNc7o54MB8rxyajibn9gCUpjhvfBjicGvric3eNA/132, createdBy=0daf5232405, createdName=卋傑, createdTime=Sun Apr 03 14:23:39 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208342, encodeId=392712083421e, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=42b38096393, createdName=ms2000000159610293, createdTime=Sun Apr 03 12:02:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1208285, encodeId=b499120828506, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78216166207, createdName=ms3000000876072209, createdTime=Sun Apr 03 07:46:23 CST 2022, time=2022-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1535331, encodeId=a63c15353317a, content=<a href='/topic/show?id=099f9020145' target=_blank style='color:#2F92EE;'>#表型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90201, encryptionId=099f9020145, topicName=表型)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b6412593156, createdName=tastas, createdTime=Mon Mar 28 07:54:33 CST 2022, time=2022-03-28, status=1, ipAttribution=)]
    2022-03-28 tastas

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