炎性因子监测联合四种评分法对短暂性脑缺血发作后近期缺血性脑卒中风险预测的价值

目的：探讨炎性因子监测联合四种评分法对短暂性脑缺血发作(TIA)后近期缺血性脑卒中风险预测价值，为其临床治疗提供参考依据。方法选择2014年1月至2016年1月秦皇岛市第四医院综合内科收治的188例TIA患者作为研究对象，纳入本研究时均采用ABCD2、埃森卒中风险评分量表(ESRS)、卒中预测工具-Ⅱ(SPI-Ⅱ)及ABCD3-Ⅰ行缺血性脑卒中风险预测，并空腹抽取静脉血检测白细胞介素(IL)-8。随访3个月记录缺血性脑卒中发生情况，并以此为终点事件，采用ROC曲线分析IL-8联合四种评分法的预测价值。结果随访3个月，188例TIA患者中有30例(16.0%)发生脑梗死。脑梗死组糖尿病、心房颤动、症状持续时间≥60 min、双重TIA、同侧颈动脉狭窄≥50.0%及DWI高信号比例高于非脑梗死组，差异均有统计学意义(P<0.05)；脑梗死组ABCD2、ESRS、SPI-Ⅱ、ABCD3-Ⅰ及IL-8均明显高于非脑梗死组，差异均有统计学意义(P<0.05)。以脑梗死发生为金标准绘制ROC曲线发现，ABCD2的AUC面积为0.694，灵敏度为73.3%，特异度为88.6%；ESRS的AUC面积为0.628，灵敏度为63.3%，特异度为57.0%；SPI-Ⅱ的AUC面积为0.551，灵敏度为60.0%，特异度为53.2%；ABCD3-Ⅰ的AUC面积为0.898，灵敏度为90.0%，特异度为93.7%；IL-8的AUC面积为0.519，灵敏度为53.3%，特异度为49.4%。IL-8并联ABCD3-Ⅰ漏诊率最低，为4.7%。结论 IL-8并联ABCD3-Ⅰ预测TIA发作后近期缺血性脑卒中漏诊率较低。

Predictive value of inflammatory factor monitoring combined with four scoring methods for short-term ischemic stroke risk after transient ischemic attack

Objective To explore the predictive value of inflammatory factor monitoring combined with four scoring methods for short-term ischemic stroke risk after transient ischemic attack (TIA), and to provide reference for clinical treatment. Methods A total of 188 patients with TIA in Department of General Medicine in the Fourth Hospital of Qinhuangdao form January 2014 to January 2016 were selected as research objects. ABCD2, Essen Stroke Risk Score (ESRS), Stroke Prediction Tool-Ⅱ(SPI-Ⅱ) and ABCD3-Ⅰwere used to predict the risk of ischemic stroke. Fasting ve-nous blood was obtained from all patients, and the interleukin (IL)-8 was tested. The occurrence of ischemic stroke was recorded in 3 months of follow-up, as a terminal event. ROC curve was used to analylze the predictive value of IL-8 combined with four scoring methods. Results During the follow-up of 3 months, there were 30 patients (16.0%) with cerebral infarction in 188 the TIA patients. The proportion of diabetes mellitus, atrial fibrillation, duration of symptoms≥60 min, double TIA, ipsilateral carotid stenosis≥50.0%and DWI high signal in cerebral infarction group were signifi-cantly higher than those in non-cerebral infarction group, and the differences were statistically significant (P<0.05). The scores of ABCD2, ESRS, SPI-Ⅱ, ABCD3-Ⅰand IL-8 level in cerebral infarction group were significantly higher than those in non-cerebral infarction group, and the differences were statistically significant (P<0.05). The ROC curve with the occurrence of cerebral infarction as the gold standard showed that, the AUC of ABCD2 was 0.694, with the sensitivi-ty of 73.3%, specificity of 88.6%. The AUC of ESRS was 0.628, with the sensitivity of 63.3%, specificity of 57.0%. The AUC area of SPI-Ⅱwas 0.551, with the sensitivity of 60.0%, specificity of 53.2%. The AUC of ABCD3-Ⅰwas 0.898, with sensitivity of 90.0%, specificity of 93.7%. The AUC of IL-8 was 0.519, with the sensitivity of 53.3%, specificity of 49.4%. The rate of missed diagnosis of IL-8 paralleling ABCD3-Ⅰwas the lowest, which was 4.7%. Conclusion IL-8 ABCD3-Ⅰin paralleling has a low missed diagnosis rate for predicting short-term ischemic stroke risk after transient ischemic attack.