联合评分评估 TIA 后早期卒中风险的应用研究

目的：探讨联合评分方法对短暂性脑缺血发作（transient is chemic attack ,TIA）后早期卒中风险进行评估的效能。方法收集120例TIA患者,通过头DWI明确有无新鲜梗死。入院后对患者进行ABCD2评分,检测患者血清超敏C反应蛋白（hypersensitive C-reactive protein ,hs-CRP）、血浆纤维蛋白原（fibrinogen ,FIB）的含量。在ABCD2评分基础上,结合血清hs-CRP、FIB结果形成联合评分,对比分析 TIA后1周内ABCD2评分与联合评分两种方法的评估效能。结果120例T IA患者中,39例（32.5％）在发病1周内发生脑梗死。ABCD2评分与联合评分两种方法结果一致,脑梗死发病率由高到低顺序为：高危＞中危＞低危。联合评分低、中危组人数减少,高危组人数增加。与ABCD2评分比较,联合评分低、中危组脑梗死发病率降低,高危组脑梗死发病率升高。联合评分的ROC曲线下面积显著大于ABCD2评分（P＜0.001）。结论结合临床生化检验结果的联合评分效能高于单纯的ABCD2评分,联合评分能更好预测高危人群T IA后早期进展为脑梗死的风险,可用于临床指导T IA危险分层和治疗。     

ABCD2评分与ESSEN评分对TIA再发风险的评估

目的 用ABCD2评分与ESSEN评分评估短暂性脑缺血发作(TIA)后的再发风险.方法 应用ABCD2评分和与ESSEN评分对168例门诊和住院的TIA患者进行评分,观察短暂性脑缺血发作患者7 d和90 d内TIA再发的情况.结果 短暂性脑缺血发作后7 d内TIA再发率为14.3%,90 d内TIA再发率为18.4%,ABCD2评分预示7 d TIA再发风险的敏感性为66.7%,特异性为54.2%,ESSEN评分的敏感性为75.0%,特异性为59.0%;ABCD2评分预示90 d脑卒中再发风险的敏感性为54.8%,特异性为56.2%,ESSEN评分的敏感性为74.2%,特异性为60.6%.结论 ABCD2评分和ESSEN评分都能预测短暂性脑缺血发作后的再发风险,但特异性和敏感性都不高.     

ABCD2评分对短暂性脑缺血发作后卒中严重程度的评估价值

目的：初步探讨ABCD2评分方法对短暂性脑缺血发作后卒中严重程度的评估价值。方法选择有 T IA发作史的脑梗死患者96例,根据ABCD2评分法分成低危（0～3分）、中危（4～5分）和高危（6～7分）3组,比较高、中、低危组继发脑梗死神经功能缺损程度（NIHSS）评分。结果低危、中危和高危3组之间NIHSS评分差异无统计学意义（P＞0.05）。结论 ABCD2评分是预测T IA短期内发生脑梗死简单而有效的方法,但该评分高低可能与脑梗死神经功能缺损程度无直接相关。     

ABCD2评分对短暂性脑缺血发作患者发生脑梗死风险的评估价值

目的探讨ABCD2评分对短暂性脑缺血发作(TIA)患者发生脑梗死风险的评估价值。方法对病程<7 d的220例TIA患者应用ABCD2评分分为低危组(0～3分)和中-高危组(4～7分),观察并比较两组患者TIA发病7 d、6个月、1年内脑梗死的发生率。结果根据ABCD2评分,108例患者归为低危组,112例归为中-高危组。TIA发病7 d、6个月及1年内低危组脑梗死发生率分别为4.6%、6.5%及7.4%,中-高危组脑梗死发生率分别为18.8%、27.7%及33.9%;中-高危组TIA发病7 d、6个月及1年内脑梗死发生率显著高于低危组(均P<0.05)。结论 ABCD2评分是临床上预测TIA患者发生脑梗死的有效方法。     

ABCD2评分法结合CTA预测TIA患者近期卒中风险的临床研究

目的 探讨采用ABCD2评分法对短暂脑缺血发作(TIA)患者短期内进展为脑梗死的预测价值;评价脑血管狭窄与TIA患者脑梗死发生率及ABCD2评分之间的关系.方法 按照Johnston等对TIA的ABCD2评分标准,测定98例TIA患者的评分并危险分组,观察其2、7d内脑梗死的发生率,比较各危险组之间卒中率的差异;通过CTA评估脑血管狭窄,并分为血管狭窄≥50％组与血管狭窄＜50％组,分析脑血管狭窄与2、7d内脑梗死的发生率的关系,评价ABCD2评分与脑血管狭窄之间的相关性.结果 (1)评分≤3分的TIA患者有40例.2、7d发生脑梗死的例数分别为0例(0％)、2例(5％);评分为4～5分的患者46例,2、7d进展为脑梗死的例数分别为4例(8.7％)、11例(23％);评分≥6分的患者12例,2、7d进展为脑梗死的例数分别为3例(25％)、4例(33.3％).不同ABCD2评分值的TIA患者,其脑梗死发生率差异均有统计学意义(P均＜0.05).(2)脑血管狭窄≥50％组与狭窄＜50％组比较,TIA后7d内卒中发生率明显增高,且其脑梗死发生率差异有统计学意义(21.4％ vs 5.6％,P=0.04).(3)血管狭窄≥50％组与狭窄＜50％组比较,中、高危的比率增高(46.4％ vs 19.4％),且其比率增高有统计学意义(P=0.02).结论 (1) ABCD2评分能够预测TIA患者2、7d内卒中发生率,是临床预测TIA短期进展为脑梗死的一种简便、有效的方法.ABCD2评分值不同的TIA患者,脑梗死的发生率不同,分值越高,发生率越高.(2)合并中重度血管狭窄的TIA患者较脑血管无明显狭窄的TIA患者更易发生脑梗死.(3)ABCD2评分与脑血管狭窄具有相关性.     

MSCTA联合ABCD2评分对短暂性脑缺血发作早期进展为脑梗死的预测价值

目的 探究MSCTA联合ABCD2评分对短暂性脑缺血发作早期进展为脑梗死的预测价值。方法 选取2016年6月-2017年6月本院收治的短暂性脑缺血发作(TIA)患者共92例,对所有患者行MSCTA检查以及采用ABCD2评分进行危险分层与评估,观察不同动脉狭窄程度与不同ABCD2评分下TIA患者脑梗死的发生率以及MSCTA联合ABCD2评分对TIA患者早期进展为脑梗死的预测价值。结果 轻度、中度动脉狭窄患者在1周内脑梗死的发生率明显低于重度狭窄患者(P<0.05); ABCD2评分低危组与中危组患者在1周内脑梗死的发生率显著低于高危组(P<0.05); MSCTA联合ABCD2评分预测脑梗死的特异度、灵敏度、准确度、阳性预测值和阴性预测值均明显高于单独MSCTA与ABCD2评分(P<0.05)。结论 MSCTA联合ABCD2评分对短暂性脑缺血发作患者早期进展为脑梗死具有较高的预测价值。     

前循环TIA患者血清总胆红素水平与ABCD2评分

目的探讨动脉粥样硬化(AS)性前循环短暂性脑缺血发作(TIA)患者血清总胆红素(T.Bil)水平与其ABCD2评分的相关性。方法收集前循环TIA患者133例进行ABCD2评分,根据评分分为低危亚组、中危亚组和高危亚组,收集其血清T.Bil水平资料,比较三组间血清T.Bil平均水平,分析血清T.Bil水平与ABCD2评分的相关程度及其临床意义。结果 TIA患者血清T.Bil水平较对照组显著降低,差异有统计学意义(P<0.05)。Kruskal-Wallis H检验显示,三组间血清T.Bil平均水平差异有统计学意义(P=0.004),高危亚组[(7.59±2.05)μmol/L]低于中危亚组[(9.45±3.08)μmol/L],中危亚组低于低危亚组[(11.53±2.26)μmol/L](均P<0.05)。经Spearman秩相关系数检验,血清T.Bil水平与ABCD2评分呈负相关(r=-0.269,P=0.002)。结论 TIA患者血清T.Bil水平随ABCD2评分的增高而降低,并与ABCD2评分呈负相关。     

表现为短暂性脑缺血发作患者ABCD2评分与hs-CRP的相关性分析

目的探讨以短暂性脑缺血发作(TIA)为表现患者的ABCD2评分与血清超敏C反应蛋白(hs-CRP)的相关性。方法326例临床表现为TIA的患者,于发病1周内入院,并查头颅DWI了解是否有高信号。按照DWI是否有高信号分为脑梗死组与非脑梗死组,测定血清hs-CRP水平,观察所有患者ABCD2评分与hs-CRP水平的相关性,且比较2组ABCD2评分及hsCRP。结果 ABCD2评分与hs-CRP水平呈正相关,且脑梗死组ABCD2评分和hs-CRP水平高于非脑梗死组,差异有统计学意义(P0.05)。结论 hs-CRP水平与ABCD2评分具有很好的相关性,ABCD2评分越高,TIA发生率越高,hs-CRP越高越能反映动脉粥样硬化程度,二者联合有利于评估TIA患者病情风险与指导治疗。     

ABCD2评分对TIA后短期内发生脑梗死的预测价值

目的观察分析短暂性脑缺血发作(TIA)患者7 d和30 d内进展为脑梗死的危险因素。方法以81例TIA为观察对象,收集其临床资料,并按Johnston提出的7分ABCD2评分法给予评分,随方TIA患者7 d和30 d内脑梗死的发生率。结果 TIA发生后31例(38.2%)患者于30 d内发生脑梗死,其中19例(23.4%)发生于7 d内。ABCD2评分≥4分是TIA后发生脑梗死独立危险因素。结论 ABCD2评分多的TIA患者短期内脑梗死的发生危险性较高,应及时住院治疗,抗血小板聚集和抗凝治疗可使TIA患者降低脑梗死发生风险。     

ABCD2评分结合hs-CRP对短暂性脑缺血发作后发生脑梗死的评估价值

目的 探讨短暂性脑缺血发作（transient ischemic attack,TIA）患者ABCD2评分与血清超敏C反应蛋白（hs-CRP）水平的关系,及ABCD2评分法预测TIA进展为脑梗死的价值.方法 测定79例TIA患者（TIA组）和40例健康体检者（对照组） 血清hs-CRP水平,TIA组按ABCD2评分分为高危组、中危组和低危组,比较3组间hs-CRP水平,并观察其2 d、7 d内脑梗死的发生率.结果 TIA组血清hs-CRP水平高于对照组（P〈0.05）;高、中、低危组间血清hs-CRP水平差异均有统计学意义（P〈0.05）,评分≤3分的TIA患者22例,2 d、7 d发生脑梗死分别为1例（4.5%）、2例（9.1%）;评分为4或5分的患者31例,2 d、7 d进展为脑梗死分别为3例（9.7%）、5例（16.1%）;评分≥6分的患者26例,2 d、7 d进展为脑梗死分别为7例（26.9%）、10例（38.5%）.不同ABCD2评分值的TIA患者,其脑梗死发生率差异均有统计学意义（P均〈0.05）.结论 TIA患者ABCD2评分与血清hs-CRP水平关系密切,两者呈正相关.ABCD2评分值不同,脑梗死的发生率不同,分值越高,发生率越高,联合二者更有助于TIA的指导治疗和风险评估.     

ABCD评分系统预测TIA后近期卒中危险性的研究进展

TIA是有效预防脑梗死的重要阶段。使患者在卒中发生前得到早期甄别和有效医疗干预,是临床上的重要课题。2005年Rothwell等报道一种基于患者年龄、血压、临床特征、症状持续时间的六分评分系统（ABCD）,能有效地对TIA后近期卒中的危险性进行分层。此后,许多学者对其临床有效性作了积极的验证研究,并相继进行了一些改良,提出了ABCDI、ABCD2等等。总的来说,不论哪一种评分系统,在得到广泛应用之前,必须先在不同的患者群中进一步验证。     

Intellectual function in patients with transient ischaemic attacks (TIA) or minor stroke

Psychological testing was performed in 25 patients (mean age 56 years) with transient ischaemic attacks and/or minor strokes and with angiographically verified internal carotid artery stenosis. The effects of carotid endarterectomy on intellectual functions were evaluated postoperatively at 2 weeks and 8 months respectively. Preoperatively the mean test values were below the normal level for all tests indicating a general intellectual impairment for the group as a whole. This may reflect multiinfarct dementia in statu nascendi . At the early postoperative test session some test results were statistically significantly worse than the preoperative. 8 months postoperatively the mean values for all tests had improved as compared with the preoperative values. This improvement reached a statistically significant level in 6 tests. When the side of operation was considered a pattern emerged: in the 12 patients with left-sided endarterectomies improvement was significant for tests mainly related to left-hemisphere function (Word Pairs Test, Story Recall, Trail Making B, Similarities) and in the 13 patients with right-sided endarterectomies significant improvement occurred in the functions mainly related to the right hemisphere (Visual Gestalts, Block Design, Digit Span backwards). This relationship between side of operation and improvement in lateralized functions cannot be explained by retest effects.
It is concluded that TIA's and minor strokes per se may impair intellectual function, and that reversal of deterioration and even improved mental state may follow carotid endarterectomy.     

Assessment of ABCD2 scale in patients with transient ischaemic attack or stroke

Background and purposeStroke risk prediction scores have been designed to stratify risk of recurrent cerebrovascular events in patients with transient ischaemic attack (TIA) or minor ischaemic stroke (MIS).Material and methodsConsecutive patients with TIA or MIS referring to Ghaem Hospital, Mashhad presenting within 24 hours from the onset of symptoms were recruited to the prospective cohort study between 2010 and 2011. MIS was defined as an ischaemic stroke with National Institutes of Health Stroke Scale (NIHSS) score < 4. The end-point of the study was a new ischaemic cerebrovascular event or vascular death at 90 days and, additionally, at 3 days after the index TIA or MIS. The decision to admit and of method of treatment in each case was left to the discretion of the stroke neurologist. The predictive accuracy of the ABCD² scoring system for recurrent stroke or TIA was quantified by the area under the curve (AUC), using the c-statistics.ResultsThe study included 393 patients with TIA (238 males, 155 females) and 118 patients with MIS (77 males, 41 females). Among 511 patients with minor ischaemic events, 117 strokes (23.2%), 99 TIAs (19.6%), and 11 vascular deaths (2.2%) occurred within 3 months after the index event. The ABCD² score had a weak predictive value for 3-month and 3-day recurrent stroke in patients with TIA (AUC = 0.599 and 0.591, respectively), but a high predictive value for 3-month and 3-day recurrent stroke in patients with MIS (AUC = 0.727 and 0.728, respectively).ConclusionsThe ABCD² score is highly predictive for short-term recurrent stroke in patients with MIS but not in patients with TIA, although it was originally designed for patients with TIA.     

The association between high on-treatment platelet reactivity and early recurrence of ischemic events after minor stroke or TIA

Objectives: To evaluate the role of HTPR in predicting early recurrence of ischemic events in patients with minor ischemic stroke or high-risk TIA.

Methods: From January 2014 to September 2014, a single center continuously enrolled patients with minor ischemic stroke or high-risk TIA and gave them antiplatelet therapy consisting of aspirin with clopidogrel. HTPR was assessed by TEG after 7 days of antiplatelet therapy and detected CYP2C19 genotype. The incidence of recurrent ischemic events was assessed 3 months after onset. The incidence of recurrent ischemic events was compared between the HTPR and NTPR groups with the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to determine the risk factors associated with recurrent ischemic events.

Results: We enrolled 278 eligible patients with minor ischemic stroke or high-risk TIA. Through TEG testing, patients with HTPR were 22.7%, and carriers were not associated with HTPR to ADP by TEG-ADP(%) (p = 0.193). A total of 265 patients completed 3 months of follow-up, and Kaplan-Meier analysis showed that patients with HTPR had a higher percentage of recurrent ischemic events compared with patients with NTPR (p = 0.002). In multivariate Cox proportional hazards models, history of ischemic stroke or TIA (HR 4.45, 95% CI 1.77–11.16, p = 0.001) and HTPR (HR 3.34, 95% CI 1.41–7.91, p = 0.006) was independently associated with recurrent ischemic events.

Discussion: In patients with minor stroke or TIA, the prevalence of HTPR was 22.7%, and HTPR was independently associated with recurrent ischemic events.     

Hypodensity of the cerebral white matter in patients with transient ischemic attack or minor stroke: influence on the rate of subsequent stroke. Dutch TIA Trial Study Group.

In a prospective study of 3,017 patients with transient ischemic attack or minor ischemic stroke from the Dutch Transient Ischemic Attack Trial, the presence or absence of diffuse hypodensity of the white matter on a baseline computed tomography (CT) scan of the brain was related to the occurrence of subsequent stroke. On entry, 337 patients were judged to have diffuse hypodensity of the white matter on CT; they were older (71.4 +/- 7.4 years versus 64.4 +/- 9.9 years), more often had hypertension (50% versus 41%), and more often had lacunar infarcts on CT scan (40% versus 26%) than did patients with normal white matter. Strokes, fatal or nonfatal, occurred in 51 (15%) of the patients with diffuse hypodensity of the cerebral white matter, compared to 217 (8%) in the group with normal white matter (crude hazard ratio, 2.0; 95% confidence interval, 1.4-2.7). After adjustment for age and other relevant entry variables, the hazard ratio was 1.6 (95% confidence interval, 1.2-2.2). In patients younger than 70 years the crude hazard ratio was 2.7 (95% confidence interval, 1.7-4.2). The distribution between the main subtypes of stroke was similar for patients with and those without diffuse hypodensity of the cerebral white matter: Intracerebral hemorrhage occurred in 6 and 9%, cortical infarction in 47 and 45%, and lacunar infarction in 34 and 29%, respectively. We conclude that hypodensity of the cerebral white matter in patients with transient ischemic attack or minor stroke is associated with an extra risk of future stroke, from large as well as from small vessels, and particularly in patients under 70 years old; this increase of risk is independent of other risk factors for stroke.     

Silent stroke in patients with transient ischemic attack or minor ischemic stroke. The Dutch TIA Trial Study Group.

BACKGROUND AND PURPOSE: We studied silent stroke (i.e., infarcts on computed tomographic scan not related to later symptoms) in patients after transient ischemic attack or minor ischemic stroke. METHODS: Ours is a cross-sectional study of 2,329 patients who were randomized in a secondary prevention trial after transient ischemic attack or minor ischemic stroke and had no residual deficit after the qualifying event. RESULTS: Silent stroke was observed in 13% of the 2,329 patients. Lacunes formed 79%, cortical lesions 14%, and border zone lesions 7% of all silent strokes. Silent lacunes were most often located in the basal ganglia and symptomatic lacunes most often in the corona radiata. Age, hypertension, and current cigarette smoking were related to the presence of silent stroke. Silent stroke was equally common in different types of transient ischemic attack, including transient monocular blindness. Residual symptoms of any kind were more common in patients with silent stroke than in those without. CONCLUSIONS: Because only the sites of silent stroke infarcts differed slightly from those of symptomatic infarcts and the frequency of vascular risk factors was similar to that of symptomatic infarcts, silent stroke may have the same bearing on future risk as known prior stroke.     

Differences in the outcome of patients with TIA versus minor stroke

In the Swedish aspirin low dose trial (SALT) 101 patients were enrolled from the Department of Medicine, Falun. 42 patients had experienced TIA/amaurosis fugax, whereas 59 patients had suffered a minor stroke/retinal infarction. History of hypertension treated or known untreated occurred statistically more frequently in the minor stroke group at randomisation (P less than 0.01) and the mean diastolic blood pressure (DBP) was higher in the minor stroke group during the observation time (P less than 0.05; ANOVA). The minor stroke group had less favourable outcomes according to survival curves (stroke or death) during a mean observation time of 34 months in each group (P less than 0.05 at 29 months). The findings of the present trial suggest that hypertension and the higher mean DBP during the observation time might explain the better outcome of end points of stroke or death in patients with TIA.