HALP联合NIHSS评分预测首发缺血性脑卒中患者急性期认知障碍的价值

Predictive Value of HALP Combined with NIHSS Scores for Acute Cognitive Impairment in Patients with First-Ever Is-chemic Stroke

摘要: 目的：探讨HALP (血红蛋白、白蛋白、淋巴细胞计数及血小板计数) + NIHSS评分对首发缺血性卒中并发认知障碍风险的预测价值。方法：收集我院确诊的190例首次发病的缺血性脑卒中(Acute Is-chemic Stroke, AIS)患者的临床资料。根据蒙特利尔认知量表(Montreal Cognitive Assessment, MOCA)评估结果分为卒中后认知障碍(Post-Stroke Cognitive Impairment, PSCI)组和非PSCI组，对两组患者的临床资料进行比较。采用二元Logistic回归分析评价影响首次AIS发生认知障碍的影响因素，并通过受试者工作特征曲线(Receiver Operating Characteristic Curve, ROC)分析HALP评分及其联合NIHSS评分对首次发病的AIS患者急性期发生认知功能障碍的预测效果。结果：多因素逻辑回归分析显示患者年龄(aOR = 1.03 95% CI 0.99~1.07)、梗死数量 ≥ 2个(aOR = 2.62 95% CI 1.26~5.59)、入院NIHSS评分(aOR = 1.19 95% CI 1.00~1.43)、小学或文盲(a OR = 4.10 95% CI 1.73~10.30)均为急性脑梗死并发认知障碍的危险因素(p < 0.05)。大专及以上文化程度(aOR = 0.21 95% CI 0.05~0.68)、HALP评分(OR = 0.97 95% CI 0.96~0.99)为患者认知障碍发生的保护因素(p < 0.05)。ROC曲线分析显示，HALP + NIHSS联合评分曲线下面积为0.735 (95% CI = 0.663~0.806)。结论：HALP + NIHSS联合评分对首次发病AIS急性期出现认知障碍的患者有一定的临床预测价值。

Abstract: Objective: Investigating the predictive value of HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet Counts) combined with NIHSS (National Institutes of Health Stroke Scale) scores for the risk of developing cognitive impairment in first-ever ischemic stroke. Methods: A total of 190 patients diagnosed with the first-ever AIS were included, and their clinical data were collected for analysis. Based on the Montreal Cognitive Assessment (MOCA) results, patients were categorized into the post-stroke cognitive impairment (PSCI) group and non-PSCI group for comparison. The clinical data of the two groups were compared. Binary logistic regression analysis was conducted to assess the factors influencing cognitive impairment in first-ever AIS. Additionally, the predictive effects of HALP score and its combination with NIHSS score for acute-phase cognitive impairment in first-ever AIS patients were evaluated using receiver operating characteristic curve (ROC) analysis. Results: Multivariate logistic regression analysis revealed that patient age (aOR = 1.03, 95% CI 0.99~1.07), ≥2 infarct lesions (aOR = 2.62, 95% CI 1.26~5.59), admission NIHSS score (aOR = 1.19, 95% CI 1.00~1.43), and primary school education or illiteracy (aOR = 4.10, 95% CI 1.73~10.30) were iden-tified as risk factors for acute ischemic stroke with concurrent cognitive impairment (p < 0.05). On the other hand, higher education (college or above) (aOR = 0.21, 95% CI 0.05~0.68) and HALP score (OR = 0.97, 95% CI 0.96~0.99) were found to be protective factors against cognitive impairment occurrence in patients (p < 0.05). Notably, the ROC curve analysis demonstrated that the combined HALP + NIHSS score had an area under the curve of 0.735 (95% CI = 0.663~0.806). Conclusion: The results indicate that the combined HALP + NIHSS score holds potential as a clinically useful tool for predicting the occurrence of cognitive impairment in patients with first-ever AIS during the acute phase.