ABCD~2责任血管狭窄评分预测TIA后早期卒中的价值

发布时间：2018-08-06 07:52

【摘要】：目的：评估ABCD2责任血管狭窄评分对短暂性脑缺血发作（transient ischemicattack，TIA）患者7天内发生脑梗死的预测价值，比较ABCD2评分与ABCD2责任血管狭窄评分的有效性。 方法：以2012年3月至2013年12月由皖南医学院附属弋矶山医院神经内科收住院的67例TIA患者为研究对象，收集其临床病史资料及影像学检查结果，随访观察7天内脑梗死发生人数。按照ABCD2评分进行评分并分为低危（0~3分）、中危（4~5分）、高危（6~7分）三组，比较各组之间7天内脑梗死发生率。所有病例依据临床特征确定责任血管，在住院期间行磁共振血管造影术（magneticresonance angiography，MRA）测量责任血管狭窄程度。根据责任血管狭窄程度将病例分为≥50%组和＜50%组，比较两组脑梗死发生率。依照不同ABCD2评分分组、不同责任血管狭窄程度再次进行分组，比较各组的脑梗死发生率。在ABCD2评分中，加入责任血管狭窄程度（2分）这一影响因素，形成ABCD2责任血管狭窄评分，并分为低危（0~3分）、中危（4~6分）、高危（7~9分）三组，比较各组之间脑梗死发生率。通过绘制ROC曲线，，评估ABCD2评分及ABCD2责任血管狭窄评分对TIA发作后7天内脑梗死发生风险的预测价值。 结果：67例TIA患者中，18例在7天内发生脑梗死。按照ABCD2评分分组，低危组30例，3例发生脑梗死；中危组31例，11例发生脑梗死；高危组6例，4例发生脑梗死，差异具有统计学意义（P0.05）。责任血管狭窄≥50%组27例TIA患者，12例发生脑梗死；50%组40例，6例发生脑梗死，两组之间具有统计学差异（P0.05）.按照ABCD2责任血管狭窄评分分组，低、中、高组的脑梗死发生率分别为10.7%、28.1%、85.7%，差异有统计学意义（P0.05）.绘制ROC曲线，ABCD2责任血管狭窄评分曲线下面积0.763（0.663~0.863）高于ABCD2评分曲线下面积0.680(0.570~0.790)。 结论：1.ABCD2评分高危组、中危组脑梗死发生率与低危组比较具有显著统计学差异；ABCD2评分越高，TIA后早期脑梗死发生率也越高。 2.责任血管狭窄≥50%是TIA后发生脑梗死的危险因素； ABCD2责任血管狭窄评分与TIA后脑梗死发生率具有正相关关系，评分越高，脑梗死发生率越高。 3.ABCD2责任血管狭窄评分各危险组之间脑梗死发生率具有显著差异，可以用ABCD2责任血管狭窄评分来评估TIA患者的卒中风险。 4.ABCD2责任血管狭窄评分ROC曲线下面积大于ABCD2评分ROC曲线下面积，且具有统计学差异，提示，ABCD2责任血管狭窄评分有效性较高，更具有临床实用价值。
[Abstract]:Objective: to evaluate the predictive value of ABCD2 responsible vascular stenosis score for cerebral infarction in patients with transient ischemic attack (transient) within 7 days, and to compare the effectiveness of ABCD2 score and ABCD2 responsible vascular stenosis score. Methods: from March 2012 to December 2013, 67 patients with TIA were collected from the Department of Neurology, affiliated to the Southern Anhui Medical College, and their clinical history and imaging findings were collected. Patients with cerebral infarction were followed up for 7 days. According to ABCD2 score, the patients were divided into three groups: low risk (0 ~ 3), moderate risk (4 ~ 5) and high risk (6 ~ 7). The incidence of cerebral infarction within 7 days was compared among the three groups. In all cases, the responsible vessels were determined according to the clinical features, and the degree of stenosis was measured by magneticresonance angiography. According to the degree of stenosis of responsible vessels, the patients were divided into 鈮

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