ABCD2评分联合血浆纤维蛋白原水平早期预测短暂性脑缺血发作患者发生脑梗死的风险  

ABCD2 score combined with plasma fibrinogen level in the early prediction of transient ischemic stroke patients' risk of cerebral infarction

作　　者：郗红艳[1] 司志华[1] 李家承[1] 朱建国[1] 闫海燕[1] XI Hongyan;SI Zhihua;LI Jiacheng;ZHU Jianguo;YAN Haiyan(Department of Neurology,Harrison International Heping Hospital,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院神经内科,衡水市053000

出　　处：《疑难病杂志》2018年第11期1200-1204,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的分析神经内科临床评分量表(ABCD2)评分联合血浆纤维蛋白原(Fib)对短暂性脑缺血发作(TIA)患者早期发生脑梗死风险的预测价值。方法选择2016年6月—2017年12月哈励逊国际和平医院神经内科收治的TIA患者150例作为TIA组,根据ABCD2评分分为低危亚组(≤3分) 59例、中危亚组(4~5分) 48例和高危亚组(≥6分) 43例。选择同期在医院体检中心体检的健康者100例为健康对照组。比较2组一般临床资料、实验室检查指标,并记录TIA各亚组患者7 d和90 d发生脑梗死情况。根据纤维蛋白原水平分为≥3. 5 g/L亚组64例和<3. 5 g/L亚组86例,比较二者7 d和90 d发生脑梗死情况。应用ROC曲线分析计算曲线下面积(AUC),评价ABCD2评分、血浆纤维蛋白原及二者联合对预测脑梗死的价值。结果与健康对照组比较,TIA组TC、TG、CRP、Fib、D二聚体(D-D)差异有统计学意义(t=-9. 077、-11. 161、-25. 537、-19. 556、-22. 560,P均<0. 01)。ABCD2评分越高,TIA患者年龄越大,且患高血压、糖尿病比例越高,比较差异有统计学意义(χ~2=5. 360、6. 341、6. 341,P <0. 05),纤维蛋白原比较为高危亚组>中危亚组>低危亚组,差异有统计学意义(F=81. 398,P <0. 01),低危亚组发生脑梗死5例(8. 5%),中危亚组20例(41. 7%),高危亚组29例(67. 4%),3组比较差异有统计学意义(χ~2=11. 89,P <0. 001)。Fib <3. 5 g/L亚组患者发生脑梗死15例(17. 4%),Fib≥3. 5 g/L亚组患者发生39例(60. 9%),2组比较差异有统计学意义(χ~2=30. 130,P <0. 001)。ABCD2评分、Fib及二者联合预测TIA后7 d发生脑梗死的ROC曲线下面积分别为0. 820、0. 728、0. 875; ABCD2评分、Fib及二者联合预测TIA后90 d发生脑梗死的ROC曲线下面积分别为0. 774、0. 651、0. 823,可见二者联合预测TIA后7 d、90 d发生脑梗死价值最高。结论 ABCD2评分越高、纤维蛋白原水平越高,TIA患者早期发生脑梗死的几率越高,ABCD2评分联合纤维蛋白原检测较单独应用预Objective To evaluate the predictive value of ABCD2 score combined with plasma fibrinogen for the early onset of cerebral infarction in patients with transient ischemic attack(TIA).Methods A retrospective analysis of 150 patients with TIA in Department of Neurology,Harrison International Heping Hospital from June 2016 to December 2017 were included,according to ABCD2 score,they were divided into low risk group(less than 3)with 59 cases,medium risk group(4-5)with 48 cases,high risk group(more than 6)with 43 cases.The general clinical data and laboratory examination indexes were compared and the cerebral infarction was recorded at 7 and 90 days in each group.According to the level of fibrinogen,they were divided into more than 3.5 g/L in 64 cases,<3.5 g/L in 86 cases,compared 2 groups of 7 days and 90 days’occurrence of cerebral infarction.The value of ABCD2 score,plasma fibrinogen and the combination for predicting cerebral infarction were evaluated by using the ROC curve to calculate the area under the curve(AUC).Results Compared with the healthy control group,the difference of TC,TG,CRP,Fib and D-Dimer in the TIA group was statistically significant(t=-9.077,t=-11.161,t=-25.537,t=-19.556,t=-22.560,P<0.01).The higher the ABCD2 score,the older the TIA patients were,the higher the proportion of hypertension and diabetes,the difference was statistically significant(χ2=5.360,χ2=6.341,χ2=6.341,P<0.05).The fibrinogen was compared to the high risk subgroup>middle risk subgroup>low risk subgroup,the difference was statistically significant(F=81.398,P<0.01),and the low risk subgroup had cerebral infarction.There were 5 cases(8.5%),20 cases(41.7%)in the middle risk subgroup,and 29 cases(67.4%)in the high-risk subgroup.The difference between the 3 groups was statistically significant(χ2=11.89,P<0.001).There were 15 cases of cerebral infarction(17.4%)in Fib<3.5 g/L patients and 39 cases(60.9%)in Fib>3.5 g/L patients.The difference between the 2 groups was statistically significant(χ2=30.130,P<0.001).The area under ROC

关 键 词：ABCD2评分 纤维蛋白原 短暂性脑缺血发作 脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]