摘要目的:探讨V 1导联P波终末电势（PTFV 1）联合洛桑（ASTRAL）评分对急性缺血性卒中患者不良功能预后的预测价值。 方法:本研究是前瞻性队列研究，连续纳入2019年1月至2021年12月于郑州大学第一附属医院住院的发病7 d内的缺血性卒中患者。收集患者基线信息，测量患者PTFV 1，计算ASTRAL评分。结局事件为1年不良功能预后（改良Rankin评分>2分）。通过建立Logistic回归模型，分析PTFV 1对不良功能预后的预测价值。将PTFV 1加入ASTRAL评分，拟合P-ASTRAL评分。通过绘制受试者工作特征（ROC）曲线，计算曲线下面积（ AUC），验证模型的预测价值。 结果:最终纳入3?399例患者，年龄（59±12）岁，年龄范围14~95岁。其中男占70.3%（2?390/3?399），PTFV 1增大的比例为8.8%（299/3?399）。与改良Rankin评分≤2分的患者相比，功能预后不良患者年龄更大（ t=12.40， P<0.001）、男性更多（ χ2=23.85， P<0.001）、有更多的危险因素[糖尿病（ χ2=5.54， P=0.019）、既往卒中病史（ χ2=56.38， P<0.001）、冠心病（ χ2=22.72， P<0.001）]、PTFV 1增大的比例更多（ χ2=229.65， P<0.001）及ASTRAL评分更高（ χ2=424.02， P<0.001）。矫正混杂因素后，PTFV 1增大（ OR=4.168，95% CI 3.101~5.602， P<0.001）及ASTRAL评分增加（ OR=1.122，95% CI 1.097~1.148， P<0.001）是会增加1年不良功能结局的风险。ASTRAL评分对1年不良功能预后的预测价值高于ASTRAL评分（ AUC：0.753对0.739， Z=2.317， P=0.021）。 结论:PTFV 1是缺血性卒中患者不良预后的危险因素，P-ASTRAL评分可以提高对缺血性卒中不良结局的预测价值。

abstractsObjective:To investigate the predictive value of adding P-wave terminal force in lead V 1 (PTFV 1) to ASTRAL score for poor functional prognosis in patients with acute ischemic stroke. Methods:The study was a prospective cohort study. The hospitalized ischemic stroke patients within 7 days of onset from January 2019 to December 2021 in The First Affiliated Hospital of Zhengzhou University were enrolled. The baseline characteristics were collected, the values of PTFV 1 were measured, and ASTRAL scores were evaluated. The unfavorable outcome was defined as 1-year modified Rankin Scale score (mRS) >2. Logistic regression model was conducted to determine the association of PTFV 1 with unfavorable outcome. P-ASTRAL score was established by adding PTFV 1 to ASTRAL score. The receiver operating characteristics (ROC) curves were plotted, and areas under the curves ( AUC) were calculated to evaluate the prognostic significance. Results:A total of 3?399 acute stroke patients were enrolled. The average age were (59±12) years old (range: 16-95 years), 70.3% (2?390/3?399) of patients were male, 8.8% (299/3?399) patients had an increased PTFV 1 value. In comparison with patients with mRS≤2, patients with poor functional outcome were much older ( t=12.40, P<0.001), had a higher proportion of male ( χ2=23.85, P<0.001), had much more risk factors [diabetes mellitus ( χ2=5.54, P=0.019), stroke history ( χ2=56.38, P<0.001), coronary heart disease ( χ2=22.72, P<0.001) ], had a higher proportion of increased PTFV 1 value ( χ2=229.65, P<0.001), and higher ASTRAL score ( χ2=424.02, P<0.001). After adjusting confounding factors, PTFV 1>5?000 μV·ms ( OR=4.168, 95% CI 3.101-5.602, P<0.001) and ASTRAL score ( OR=1.122, 95% CI 1.097-1.148, P<0.001) could increased the risk of 1-year poor functional outcome. The AUC for P-ASTRAL score was higher than ASTRAL score (0.753 vs. 0.739, Z=2.317, P=0.021) . Conclusion:PTFV 1 was an independent risk factor of unfavorable outcome for stroke. P-ASTRAL score could improve the predictive value of poor functional outcome for ischemic stroke.