短暂性脑缺血发作短期内脑梗死发生风险的预测  

Risk prediction of cerebral infarction in short term after transient ischemic attack

作　　者：王青川 马国诏[1] 王爱华[1] Wang Qingchuan;Ma Guozhao;Wang Aihua(Department of Neurology,Qianfoshan Hospital Affiliated to Shandong University,Ji'nan 250014,China)

机构地区：[1]山东大学附属千佛山医院神经内科,济南250014

出　　处：《中华保健医学杂志》2019年第1期13-16,共4页Chinese Journal of Health Care and Medicine

基　　金：国家自然科学基金(30870874;30600202;30710303072);山东省心脑血管疾病重大疾病基因检测技术研究平台重点研发基金(2014-614);国家科技支撑计划课题(2013BAH19F00)

摘　　要：目的分析ABCD2(年龄、血压、临床症状、持续时间、糖尿病)评分、磁共振弥散加权成像(DWI)、颅内动脉磁共振血管成像(MRA)等特征预测短暂性脑缺血发作(TIA)短期内脑梗死发生风险的参考价值。方法选取2013年7月～2018年7月山东大学附属千佛山医院神经内科收治的311例TIA患者,就其ABCD2评分DWI及MRA特征进行分析,运用直线回归分析及受试者工作特征曲线(ROC),计算ABCD2评分与TIA发作后脑梗死发生的相关性,以及ABCD2评分联合DWI、MRA特征预测脑梗死发生的效能。结果 ABCD2评分危险度中危、高危者,其TIA发作后2、7和30 d脑梗死发生率均高于低危者;DWI异常者,其TIA发作后2、7和30 d脑梗死发生率均高于正常者;颅内动脉狭窄率≥50%者,其TIA发作后30 d脑梗死发生率高于<50%者,差异均有统计学意义(P <0.05)。直线回归分析结果示,ABCD2评分与TIA发作后2、7和30 d脑梗死发生率均呈线性、正相关关系,即ABCD2评分越高,脑梗死发生率越高(P <0.05)。ROC曲线示,以ABCD2评分≥4分、DWI异常、颅内动脉狭窄率≥50%联合预测TIA发作后2、7和30 d后脑梗死的曲线下面积分别为0.825、0.811和0.816,提示联合预测的准确性较高(P <0.05)。结论 TIA发作短期内脑梗死发生风险较高,联合ABCD2评分及DWI、MRA特征,能够为脑梗死的预测提供可靠参考。Objective To study predictive value of ABCD2 score,diffusion-weighted magnetic resonance imaging(DWI)and intracranial magnetic resonance angiography(MRA)in predicting the risk of cerebral infarction in short term after transient ischemic attack(TIA).Methods 311 TIA cases admitted from july,2013 to july,2018 were selected,ABCD2 score and characteristics of DWI and MRA were analyzed.Linear regression analysis and ROC were used to calculate the correlation between ABCD2 score and the occurrence of cerebral infarction after TIA attack.ABCD2 score combined with DWI and MRA characteristics was effective in predicting the occurrence of cerebral infarction.Results The incidence of cerebral infarction on 2,7 and 30 days after TIA attack are higher in patients with moderate or high risk of ABCD2 score r than low risk of ABCD2 score.The incidence of cerebral infarction at 2,7 and 30 days after TIA attack was higher in patients with abnormal DWI than in patients with normal DWI.The incidence of cerebral infarction at 30 days after TIA attack was higher in the patients with more than 50%stenosis of intracranial artery than that in the patients with less than 50%stenosis of intracranial artery(P<0.05).Linear regression analysis showed that there was a linear and positive correlation between ABCD2 score and the incidence of cerebral infarction after TIA attack.The higher the ABCD2 score,the higher the incidence of cerebral infarction(P<0.05).ROC curve showed that the area under the curve was 0.825,0.811 and 0.816 respectively when ABCD2 score(>4),DWI abnormality combined with intracranial artery stenosis rate(>50%)predicted cerebral infarction 2,7 and 30 days after TIA attack,and the accuracy of prediction was higher(P<0.05).Conclusion TIA has a high risk of cerebral infarction in the short term.Combining ABCD2 score with DWI and MRA features can provide reliable reference for the prediction of cerebral infarction.

关 键 词：短暂性脑缺血发作 脑梗死 风险 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]