短暂性脑缺血发作预测脑梗死风险模型ABCD2评分的改进  

The improvement of ABCD2 scoring accuracy for predicting cerebral infarction after transient ischemic attack

作　　者：顾言[1] 陈建荣[2] 陈佳漪[1] 

机构地区：[1]南通大学第二附属医院老年科,江苏省南通226001 [2]南通大学第二附属医院急诊科,江苏省南通226001

出　　处：《中华急诊医学杂志》2016年第12期1248-1252,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨改进的ABCD2评分法对短暂性脑缺血发作（transient ischemic attack，TIA）后7d内发生脑梗死风险的预测价值。方法本研究纳入了2014年7月至2015年12月在南通大学第二附属医院就诊的133例TIA患者，记录其TIA后7d内脑梗死的发生情况。使用单因素和多因素Logistic回归分析可能导致脑梗死的危险因素。采用ABCD2联合颈动脉超声（carotid ultrasound）的改良评分法（ABCD2-CU评分法）给TIA患者进行评分。绘制受试者工作特征曲线（ROC）曲线，观察曲线下面积（AUC），评估ABCD2评分及ABCD2-CU评分对TIA后脑梗死风险的预测价值及其差异。结果133例TIA患者7d内有35例（26．3％）进展为脑梗死。单因素分析提示入院时血压≥140／90mmHg（1mmHg=0．133Kpa）、单侧肢体无力、言语障碍、持续时间≥10min、糖尿病史、高血压病史、颈动脉斑块形及颈动脉狭窄等8项危险因素与TIA后早期脑梗死密切相关（均P〈0．05）。多因素Logistic回归分析提示单侧肢体无力[OR（95％CI），3．52（1．76—12．34）]、持续时间≥10min[2．45（1．06～9．27）]、糖尿病史[3．37（1．27～10．94）]、高血压病史[4．15（1．71～13．34）]、颈动脉斑块[6．32（2．46～19．40）]及颈动脉狭窄[12．73（2．67—44．35）]是TIA后早期进展脑梗死的独立危险因素（均P〈0．05）。ABCD2-CU评分（AUC=0．802，95％CI：0．717～0．888，P=0．000）对脑梗死的预测价值高于ABCD2评分（AUC=0．614，95％CI：0．511—0．717，P=0．036）。结论ABCD2-CU评分较ABCD2评分在判断TIA后早期脑梗死风险方面有更高的临床价值，可帮助医生鉴别高危患者，以早期采取及时预防措施。Objective To investigate the application of improved ABCD2 scoring for predicting the onset of cerebral infarction within 7 days after transient ischemic attack （TIA）. Methods A total of 133 patients with TIA admitted from July 2014 to December 2015 were enrolled in this study. The ABCD2 scoring and ABCD2 combined with carotid ultrasound （CU） scoring were used to predict the risk of cerebral infarction occurred within 7 days after T1A. The univariate analysis and multivariate logistic regression analysis were performed to estimate the Contribution of clinical risk factors to triggering the cerebral infarction within 7 days after TIA. Receiver operating characteristic curve （ROC） was used to evaluate the predictive value of two different kinds of scoring process in early cerebral ini^ction after TIA. Results Of 133 patients with TIA, 35 （26. 3% ） suffered from cerebral infarction within 7 days after TIA. Univariate analysis showed cerebral infarction occurred within 7days after TIA was closely associated with BP≥ 140/90 mmHg, unilateral weakness, speech impairment, TIA duration ≥ 10 minutes, past history of hypertension, diabetes mellitus, carotid plaque, and carotid stenosis. Multivariate logistic regression analysis showed that unilateral weakness （ OR = 3.52, 95% CI： 1.76-12. 34）, TIA durations〉 10 minutes （ OR = 2.45,95% CI： 1.06-9. 27）, diabetes mellitus （ OR = 3.37, 95% CI： 1.27-10. 94）, past history of hypertension （ OR = 4. 15, 95% CI： 1.71-13.34）, carotid plaque （OR = 6. 32, 95% CI： 2. 46-19.40） , and carotid stenosis （ OR = 12.73, 95% CI： 2. 67-44. 35 ） were significantly correlated with early onset of cerebral infarction after TIA （all P 〈0. 05）. The ROC analysis revealed the ABCD2-CU scoring （ AUC = 0. 802, 95% CI： 0. 717-0. 888, P =0. 000） had a larger area under curve compared to ABCD2 scoring （AUC =0. 614, 95% CI： 0. 5114）. 717, P = 0. 036）. Conclusions The ABCD2-CU scoring was more accurate in predicting the imminent risk

关 键 词：短暂性脑缺血发作 ABCD2评分 颈动脉超声 脑梗死 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]