短暂性脑缺血发作后发生脑梗死风险的预测研究  

Study of risk prediction of cerebral infarction after transient ischemic attack

作　　者：张春良[1] 刘宏顺[1] 顾莹辉[1] 樊帆[1] 

机构地区：[1]保定市第二医院神经内科,071051

出　　处：《临床神经病学杂志》2013年第1期15-18,共4页Journal of Clinical Neurology

摘　　要：目的探讨ABCD2评分和ABCD2评分结合MRI弥散加权成像(DWI)和颅内动脉MR血管成像(MRA)对短暂性脑缺血发作(TIA)后脑梗死的预测价值。方法分别采用ABCD2评分及ABCD2+DWI+MRA评分对182例TIA患者进行评定,观察TIA后2 d、7 d和30 d内的脑梗死发生率。采用ROC曲线评估ABCD2及ABCD2+DWI+MRA评分对TIA后脑梗死风险的预测准确度。结果本组56例(30.8%)患者于30 d内发生脑梗死,其中42例(23.1%)发生于7 d内,19例(10.4%)发生于2 d内,均无脑出血发生。与低危组比较,中危组与高危组各时间点脑梗死发生率显著升高(均P<0.05)。DWI异常患者各时间点脑梗死发生率明显高于正常者(均P<0.05)。30 d时颅内动脉狭窄≥50%的患者脑梗死发生率明显高于颈内动脉狭窄<50%的患者(P<0.05)。伴DWI异常及颅内动脉狭窄≥50%的低危组患者各时间点脑梗死发生率显著高于DWI正常和颅内动脉狭窄<50%的患者(均P<0.05)。ABCD2+DWI+MRA评分预测TIA第2 d、第7d及第30 d的脑梗死率的曲线下面积显著高于ABCD2评分(均P<0.001)。结论 ABCD2评分结合DWI和MRA能进一步提高预测TIA后发生脑梗死的准确性。Objective To investigate the value of ABCD2 score and ABCD2 score combination with diffusion- weighted imaging （DWI） and magnetic resonance angiography （MRA） on predicting cerebral infarction in patients with carotid artery transient ischemic attack （TIA）. Methods The ABCD2 score and ABCD2 ＋ DWI ＋ MRA score were applied to 182 TIA patients, and the rate of cerebral infarction at 2nd d, 7th d and 30th d after TIA was observed . The predictive accuracy of ABCD2 score and ABCD2 ＋ DWI ＋ MRA score were quantified by receiver operator characteristic （ROC） curve. Results There were 56 cases （30. 8% ） had cerebral infarction within 30 d, while 42 cases （23.1% ） occurred within 7 days, 19 cases （ 10. 4% ） occurred within 2 days, and there was no cerebral hemorrhage in the group. Compared with low risk group, the rate of cerebral infarction in moderate risk group and high risk group were significently higher at the time points （ all P 〈 0. 05 ）. The rates of cerebral infarction with abnormal DWI were significantly higher than that in patients with normal DWI at each time point （ all P 〈 0. 05 ）. At 30th d, The rate of cerebral infarction in patients with intracal arterial stenosis ≥50% was significantly higher than that in patients with intracal arterial stenosis 〈 50% （ P 〈 0. 05 ）. The rates of cerebral infarction in low risk group with abnormal DWI and intracal arterial stenosis ≥50% were significantly higher than that in patients with normal DWI and intracal arterial stenosis 〈 50% （ all P 〈 0. 05 ）. The area under curve of ABCD2 ＋ DWI ＋ MRA score at 2nd d, 7th d and 30th d were significantly higher than those in ABCD2 score （ all P 〈 0. 001 ）. Conclusion The ABCD2 score combination with DWI and MRA can improve the predictive accuracy of cerebral infarction.

关 键 词：短暂性脑缺血发作 脑梗死 ABCD2评分 磁共振弥散加权成像 磁共振血管成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]