ABCD2评分联合核磁共振灌注、弥散加权成像预测短暂性脑缺血后继发性脑梗死风险的价值研究  

The value of ABCD2 score combined with nuclear magnetic resonance perfusion and diffusion weighted imaging in predicting the risk of secondary cerebral infarction after transient cerebral ischemia

作　　者：何兴林[1] 刘君[1] 官念 徐远久[2] HE Xinglin;LIU Jun;GUAN Nian;XU Yuanjiu(Department of Neurology,Guang′an People′s Hospital,Guang’an Sichuan 638000,China;Department of Clinical Laboratory,Guang′an People′s Hospital,Guang’an Sichuan 638000,China)

机构地区：[1]广安市人民医院神经内科,四川广安638000 [2]广安市人民医院检验科,四川广安638000

出　　处：《新疆医科大学学报》2019年第11期1447-1451,共5页Journal of Xinjiang Medical University

基　　金：广安市医疗卫生项目(201615073)

摘　　要：目的分析探讨ABCD2评分联合核磁共振灌注加权成像(PWI)与核磁共振弥散加权成像(DWI)对短暂性脑缺血(TIA)后继发性脑梗死风险的预测价值。方法回顾性分析于2012年2月-2018年3月广安市人民医院收治的1 376例短暂性脑缺血患者的临床资料。所有患者在入院后均于TIA发作后24h后接受ABCD2评分,并联合进行核磁共振灌注加权成像(PWI)与核磁共振弥散加权成像(DWI)。随访至TIA首次发作后90d,分别记录7d、30d、90d各时间点内发生继发性脑梗死的情况。应用Logistic回归分析法评估ABCD2评分与DWI结果与TIA后继发性脑梗死发生率的相关性,应用受试者工作特征(ROC)曲线评估预测价值。结果患者继发性脑梗死发生率在随访期内7d、30d、90d等时间点内,ABCD2评分均为高危组>中危组>低危组;而PWI、DWI结果中均是PWI(+)DWI(+)组最高。多因素Logistic回归分析结果显示:PWI(+)DWI(+)、ABCD评分4~7分以及既往合并颅内动脉病变史是TIA后继发性脑梗死发生的独立危险因素。ROC曲线结果显示以ABCD2评分≥4联合PWI、DWI结果阳性预测TIA进展风险的敏感性和特异性分别为86.3%和69.8%。结论患者出现短暂性脑缺血发作后早期联合应用ABCD2评分与PWI、DWI检查能够有效预测7d、30d、90d内继发性脑梗死的发生风险,临床可操作性强,临床价值显著,值得推广应用。Objective To analyze the value of ABCD2score combined with nuclear magnetic resonance(NMR)perfusion weighted imaging(PWI)and NMR diffusion weighted imaging(DWI)in predicting the risk of secondary cerebral infarction after transient cerebral ischemia(TIA).Methods The clinical data of 1 376patients with TIA treated in Guang′an people′s Hospital from February 2012to March 2018were analyzed retrospectively.All patients received ABCD2score 24hours after TIA attack,combined with NMR PWI and DWI.The patients were followed up to 90days after the first attack of TIA,and the incidence of secondary cerebral infarction was recorded at 7days,30days and 90days,respectively.Logistic regression analysis was used to evaluate the correlation between ABCD2score and DWI results and the incidence of secondary cerebral infarction after TIA.The working characteristic curve(ROC curve)was used to evaluate the predictive value.Results At day 7,30and 90during the follow-up period of the secondary cerebral infarction occurrance,the ABCD2score sequence was high risk group>middle risk group>low risk group,and the results of PWI and DWI were the highest in PWI(+)DWI(+)group.Multivariate Logistic regression analysis showed that:PWI(+)DWI(+),ABCD score at range of 4-7and previous history of intracranial artery disease were independent risk factors for secondary cerebral infarction after TIA.The results of(ROC)curve of subjects′working characteristics showed that the sensitivity and specificity of predicting the risk of TIA progress with ABCD2score≥4combined with PWI and DWI were 86.3%and 66.8%,respectively.Conclusion ABCD2score combined with PWI and DWI can effectively predict the risk of secondary cerebral infarction within 7days,30days and 90days after transient ischemic attack.It is worth popularizing and applying.

关 键 词：短暂性脑缺血发作 继发性脑梗死 ABCD2评分 核磁共振弥散加权成像 核磁共振灌注加权成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]