ABCD3-I评分预测短暂性脑缺血发作后早期卒中风险

目的 探讨采用ABCD3-I评分法预测短暂性脑缺血发作早期进展为卒中的风险。方法 收集在我院治疗的186例以短暂性脑缺血发作（transient ischemic attack，TIA）为首发症状的患者，均于发病后48小时内行常规弥散加权成像（diffusion weighted imaging，DWI）、磁共振成像（magnetic resonance imaging，MRI）、磁共振血管成像（magnetic resonance angiography，MRA）检查，按照ABCD3-I评分法分为低危组、中危组和高危组，观察TIA后7天、90天内各组卒中的发生率，并比较ABCD2评分法、ABCD3评分法、ABCD3-I评分法这3种评分方法的阳性预测值。采用logistic回归模型预测TIA后早期进展为卒中的危险因素。结果 ABCD3-I评分的低危组（0～3分）、中危组（4～7分）、高危组（8～13分）7天内卒中发生率分别为0、3.0%、33.8%，90天内卒中发生率分别为0、6.0%、52.3%。与低危组、中危组分别比较，高危组TIA后7天、90天内卒中发生率明显升高（P均﹤0.01）。与低危组比较，中危组90天内卒中发生率升高（P﹤0.01），两组7天内卒中发生率差异无统计学意义（P＞0.05）。Logistic回归模型显示：双重TIA患者90天内预测卒中风险比值比（odds ratio，OR）为4.307，95%可信区间（credibility interval，CI）2.317～8.005，P ﹤0.01；DWI检查出现高信号患者90天内预测卒中风险OR为1.102，95%CI 27.719～223.344，P ﹤0.01；同侧颈动脉中重度狭窄患者90天内预测卒中风险OR为7.800，95%CI 2.075～29.319，P ﹦0.005。预测7天内卒中发生风险时，ABCD2评分法、ABCD3评分法、ABCD3-I评分法的曲线下面积（area under thecurve，AUC）分别为0.627、0.842、0.900；阳性预测值分别为25.3%、68.4%、81%。预测90天卒中发生风险：ABCD2评分法、ABCD3评分法、ABCD3-I评分法的AUC分别为0.608、0.796、0.860；阳性预测值分别为21.5%、59.1%、73%。结论 ABCD3-I评分≥8分时（高危组），TIA后7天及90天内卒中发生率均升高，ABCD3-I评分≥4分时（中高危组），TIA后90天内卒中发生率升高。双重TIA、DWI检查出现高信号、同侧颈动脉狭窄与TIA后早期发生卒中相关。本研究提示ABCD3-I评分法在预测TIA进展为卒中的阳性率上，明显优于ABCD2评分法和ABCD3评分法。

Early Prediction with ABCD3-I Score for Stroke Risk after Transient Ischemic Attack

Objective To explore the ability of ABCD3-I score in predicting the early risk of stroke after transient ischemic attack（TIA）. Methods We collected in 186 consecutive patients with TIA who had diffusion weighted imagingmagnetic resonance imaging（DWI-MRI） within 48 hours of symptom onset. According to ABCDLI score, we separated into low risk group, mid risk group and high risk group. We observed the incidence of stroke within 7 days and 90 days after onset of TIA and the positive values of ABCD2 score and ABCD3 score and ABCD3-1 score were compared. Predict risk factors of stroke occurrence at early time intervals after onset of TIA by multivariate logistic regression model. Results There were no patient in low risk group（score0-4） had stroke within 7 days, 3.0% had stroke in mid risk group（score 4-7）, and 33.8% in high risk group（score 8-13）, There were no patient in low risk group had stroke within 90 days, 6.0% had stroke in mid risk group, and 52.3% in high risk group. Stroke occurrence within 7 days and 90 days after TIA were higher in high risk group compared with mid risk group and low risk group respectively（P〈0.01, P〈0.01）. Stroke occurrence within 90 days after TIA were higher in mid risk group compared with low risk group（P〈0.01 ）, but there was no significant difference between low risk group and mid risk group within 7 days after TIA（P〉0.05）. Logistic regression model showed that recurrent TIA predicted stroke within 90 days（OR=4.307, 95%CI 2.317-8.005, P〈0.01）, DWI hyperintensity predicted stroke within 90 days（OR=1.102, 95%CI 27.719-223.344, P〈0.01）. Carotid stenosis predicted stroke within 90 days（OR=7.800, 95%CI 2.075~29.319, P=-0.005）. When the occurrences of stroke were observed in 7 days, the area under the curve of ABCD2, ABCD3, ABCD3-I were 0.627, 0.842 and 0.900. The 7-day positive predictive values were 25.3%, 68.4% and 81%. In 90 days, the areas under the curve were 0.608, 0.796 and 0.860; The 90 day＇s positive predictive values were 21.5%, 59.1% and 73%. Conclusions When ABCD3-I score ≥8（high risk group）, stroke occurrence within 7 days and 90 days after TIA were higher, When ABCD3-I score ≥4（mid and high risk group）, stroke occurrence within 90 days after TIA were higher, the risk of stroke was correlated with recurrent TIA, carotid stenosis, and DWI hyperintensity after TIA. The predictive accuracy of the ABCD3-I score is evidently superior to others.