弥散加权成像联合ABCD2评分对短暂性脑缺血发作患者90d内卒中的预测价值研究

背景脑梗死尤其是多发脑梗死会导致短暂性脑缺血发作(TIA)患者卒中发生风险及轻度卒中患者卒中复发风险升高,因此通过影像学检查明确脑梗死类型有助于更有效地预测TIA患者卒中发生风险。目的分析弥散加权成像(DWI)联合ABCD2评分对TIA患者90 d内卒中的预测价值。方法选取2011年10月—2017年5月南京鼓楼医院高淳分院收治的TIA患者481例,后因影像学检查结果不完整、失访排除51例,最终共纳入430例。根据TIA后90 d内卒中发生情况将所有患者分为非卒中组(n=325)和卒中组(n=105),比较两组患者一般资料、ABCD2评分、ABCD3-I评分、梗死类型及颈动脉狭窄率≥50%情况;采用Cox比例风险回归模型分析TIA患者90 d内卒中的影响因素;绘制ROC曲线以评估ABCD2评分、ABCD3-Ⅰ评分、DWI联合ABCD2评分对TIA患者90 d内卒中的预测价值。结果(1)两组患者男性比例,有卒中史、冠心病病史、心房颤动病史、糖尿病病史、吸烟史者所占比例及血脂异常发生率比较,差异无统计学意义(P>0.05);两组患者年龄及有高血压病史、ABCD2评分≥4分、ABCD3-Ⅰ评分≥7分、颈动脉狭窄率≥50%者所占比例,梗死类型比较,差异有统计学意义(P<0.05)。(2)Cox比例风险回归模型分析结果显示,高血压病史〔HR=2.132,95%CI(1.354,3.391)〕、ABCD2评分≥4分〔HR=2.365,95%CI(1.608,3.456)〕、ABCD3-Ⅰ评分≥7分〔HR=3.210,95%CI(1.125,3.774)〕、颈动脉狭窄率≥50%〔HR=2.369,95%CI(1.880,3.691)〕、多发脑梗死〔HR=2.441,95%CI(1.620,5.117)〕是TIA患者90 d内卒中的独立危险因素(P<0.05)。(3)ROC曲线显示,ABCD2评分、ABCD3-I评分、ABCD2评分联合DWI预测TIA患者90 d内卒中的曲线下面积(AUC)为0.651〔95%CI(0.625,0.676)〕、0.724〔95%CI(0.700,0.748)〕、0.765〔95%CI(0.741,0.787)〕;DWI联合ABCD2评分预测TIA患者90 d内卒中的AUC大于ABCD2评分、ABCD3-Ⅰ评分(P<0.01)。结论TIA患者90 d内卒中发生率较高,为24.4%(105/430),而DWI联合ABCD2评分对TIA患者90 d内卒中的预测价值较高。

Predictive Value of Diffusion Weighted Imaging Combined with ABCD2 Score on Stroke within 90 Days after Transient Ischemic Attack

Background Cerebral infarction especially multiple cerebral infarction may increase the risk of stroke in patients with transient ischemic attack(TIA),as well as the recurrent risk of stroke in patients with mild stroke,thus it is helpful to determine the cerebral infarction types through imaging examination to more effectively predict the risk of stroke in patients with TIA.Objective To analyze the predictive value of ABCD2 score,ABCD3-Ⅰscore and diffusion weighted imaging(DWI)combined with ABCD2 score on stroke within 90 days after TIA.Methods A total of 481 patients with TIA were selected in Gaochun Branch of Nanjing Gulou Hospital from October 2011 to May 2017,thereinto 51 cases were excluded due to incomplete imaging findings or loss to follow-up,so 430 cases were enrolled finally.All of the enrolled 430 patients were divided into non-stroke group(n=325)and stroke group(n=105)according to the incidence of stroke within 90 days after TIA.Comparison of general information,ABCD2 score,ABCD3-Ⅰscore,infarction types and proportion of patients with carotid stenosis rate≥50%was conducted between the two groups;Cox proportional risk regression model analysis was used to analyze the influencing factors of stroke within 90 days after TIA,moreover ROC curve was drawn to evaluate the predictive value of DWI combined with ABCD2 score on stroke within 90 days after TIA.Results(1)There was no statistically significant difference in male proportion,proportion of patients with history of stroke,coronary heart disease,atrial fibrillation,diabetes or smoking,or incidence of dyslipidemia(P>0.05),while there was statistically significant difference in age,proportion of patients with hypertension,ABCD2 score≥4,ABCD3-Ⅰscore≥7 and carotid stenosis rate≥50%,as well as infarction types between the two groups,respectively(P<0.05).(2)Cox proportional risk regression model analysis results showed that,hypertension history〔HR=2.132,95%CI(1.354,3.391)〕,ABCD2 score≥4〔HR=2.365,95%CI(1.608,3.456)〕,ABCD3-Ⅰscore≥7〔HR=3.210,95%CI(1.125,3.774)〕,carotid stenosis rate≥50%〔HR=2.369,95%CI(1.880,3.691)〕and multiple cerebral infarction〔HR=2.441,95%CI(1.620,5.117)〕were independent risk factors of stroke within 90 days after TIA(P<0.05).(3)ROC curve showed that,AUC of ABCD2 score,ABCD3-Ⅰscore,DWI combined with ABCD2 score in predicting stroke within 90 days after TIA was 0.651〔95%CI(0.625,0.676)〕,0.724〔95%CI(0.700,0.748)〕,0.765〔95%CI(0.741,0.787)〕,respectively;AUC of DWI combined with ABCD2 score in predicting stroke within 90 days after TIA was statistically significantly larger than that of ABCD2 score and ABCD3-Ⅰscore,respectively(P<0.01).Conclusion Risk of stroke is relatively high within 90 days after TIA,with an incidence of 24.4%(105/430),however DWI combined with ABCD2 score has relatively high predictive on stroke within 90 days after TIA.