短暂性脑缺血发作患者ABCD3-I评分与责任血管病变特点的关系及预后分析  

Relationship between ABCD3-I score and characteristics of responsible vessels in patients with transient ischemic attack and prognosis analysis

作　　者：刘超群 胡杰 吕祥龙[1] 薛庆华[1] 李再叶 Chao-qun Liu;Jie Hu;Xiang-long Lü;Qing-hua Xue;Zai-ye Li(Department of Encephalopathy,Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine,Chuzhou,Anhui 239000,China)

机构地区：[1]滁州市中西医结合医院脑病二科,安徽滁州239000

出　　处：《中国现代医学杂志》2020年第15期85-90,共6页China Journal of Modern Medicine

摘　　要：目的探讨短暂性脑缺血发作(TIA)患者ABCD3-I评分与责任血管病变特点的关系及预后分析。方法选取2015年1月—2018年6月于滁州市中西医结合医院脑病科收治的112例TIA患者,采用ABCD3-Ⅰ评分进行危险分层,分析不同危险分层与责任血管病变的关系,另通过Logistic回归模型探讨相关危险因素,随访患者3个月,统计其脑梗死发病率。结果随着ABCD3-Ⅰ评分的增高,颅内动脉狭窄率呈升高趋势(P?<0.05),颈部血管狭窄呈下降趋势(P<0.05);颈部血管超声显示,内膜增厚(44.82%)是低危组颈部血管主要病理改变,中高危组主要表现为软斑形成(35.53%);经颅多普勒检查提示低危组患者以脑动脉弹性降低为主(52.00%),中、高危组均以颅内血管血流速度异常为主(60.53%和72.73%);低、中危组主要表现为单支血管病变(85.19%和62.50%),而高危组主要表现为多支血管病变(79.41%),同时各组供血动脉病变数比较,差异有统计学意义(P<0.05);Logistic回归分析发现,责任血管狭窄率≥50%[OlR=3.425(95%CI:1.402,8.956),P=0.008]、单侧肢体无力[OlR=4.612(95%CI:1.572,12.876),P=0.006]和不稳定斑块[OlR=3.243(95%CI:1.276,7.124),P=0.001]是90?d内进展为脑梗死的独立危险因素(P<0.05)。各组卒中发生率比较,差异有统计学意义(P?<0.05)。结论TIA患者ABCD3-I评分能够反映患者血管的狭窄程度、斑块性质及血管病变支数,结合危险因素能够早期防治脑梗死。Objective To investigate the relationship between transient ischemic attack (TIA) and ABCD3-I score.Methods The clinical and imaging data of 112 patients with TIA were retrospectively analyzed,using ABCD3-I score to risk stratification,analyzing the relationship of the different risk stratification with responsible vascular lesions.The other characters were analyzed by Logistic regression analysis to explore related risk factors.After the follow-up of patients for 3 months,the incidence of cerebral infarction was recorded.Results As the ABCD3-I score increasing,intracranial artery stenosis rate also increased (P<0.05),but the neck vascular stenosis rate showed a decreasing trend.Cervical vascular ultrasound (CVUS) showed that intimal thickening (44.82%) was the main pathological change of cervical vessels in the low-risk group,and the main manifestation in the medium-high risk group was soft plaque formation (35.53%).Transcranial Doppler examination (TCD) showed that the majority of the patients in the low-risk group were vascular wall sclerosis (52.00%),and the majority of the patients in the middle and high-risk groups were intracranial vascular blood flow velocity abnormalities (60.53%,72.73%).The main risk show in low-and middle-risk group was the single vascular lesions (85.19% and 62.50%),the main risk of high-risk group showed multiple vascular lesions (79.41%),and blood supply artery lesions among three groups were significant differences (P<0.05).Logistic regression analysis found that responsible vascular stenosis≥50% [OlR=3.425 (95% CI:1.402,8.956),P=0.008],side limb weakness [OlR=4.612 (95% CI:1.572,12.876),P=0.006],unstable plaque [OlR=3.243 (95% CI:1.276,7.124),P=0.001] were risk factors of progression within 90 d after TIA for cerebral infarction (P<0.05).The incidence of stroke in each group was significantly different (P<0.05).Conclusion ABCD3-I score of patients with TIA can reflect the degree of vascular stenosis,the nature of plaque,the number of vascular lesions,and it combined with risk fa

关 键 词：脑缺血发作 短暂性 危险因素 预后 

分 类 号：R743.31[医药卫生—神经病学与精神病学]