ABCD2评分法联合TCD或MRA对TIA近期发生脑梗死的评估价值比较

目的:比较ABCD2评分法联合经颅多普勒(TCD)或磁共振血管造影(MRA)对短暂性脑缺血发作(TIA)患者近期发生脑梗死的评估价值.方法:将2015年6月至2017年6月于本院神经内科住院治疗的70例TIA患者进行ABCD2评分,其中40例患者进行了TCD检查,30例患者进行了MRA检查,TIA发病7d内进行头颅MRI检查,统计脑梗死发生率.结果:70例患者中ABCD2评分低危患者42例,脑梗死发生率4.76%,中危患者20例,脑梗死发生率45.00%,高危患者8例,脑梗死发生率62.50%,中危组和高危组脑梗死发生率明显高于低危组(P<0.01),中危组和高危组两组间脑梗死发生率无明显差异(P>0.05).ABCD2评分联合TCD或MRA对TIA患者近期脑梗死发生的诊断曲线下面积AUC分别为0.848和0.654,且两种检测法差异有统计学意义(Z=2.43,P=0.015).多因素logistic回归分析显示,高血压、LDL≥2.6moL/L、症状持续时间≥60min均与TIA后7d内脑梗死形成呈正相关.结论:ABCD2评分对TIA短期发生脑梗死具有较好的预测价值,与TCD相比,结合MRA检查,可提高对脑梗死发生风险预测的准确性.

Comparison of the Value of ABCD2 Score Combined with TCD or MRA in the Recent Occurrence of Cerebral Infarction in TIA

Objective:To compare the value of ABCD2 score combined with transcranial Doppler ( TCD) or magnetic resonance angiography ( MRA) in the recent development of cerebral infarction in patients with transient ischemic attack ( TIA) . Methods:70 patients with TIA hospitalized in the department of neurol-ogy of our hospital from June 2015 to June 2017 were given ABCD2 score,40 patients underwent TCD, and 30 patients underwent MRA. Cranial MRI examination was performed within 7 days of onset of TIA,the inci-dence of cerebral infarction was evaluated. Results:Among the 70 patients,42 cases were ABCD2 scoring low-risk patients. The incidence of cerebral infarction was 4.76%. Among the 20 patients with moderate risk,the incidence of cerebral infarction was 45%. High-risk patients were 8 cases,the incidence of cerebral infarction was 62.50%. The incidence of cerebral infarction in high-risk group and high-risk group was significantly higher than that in low risk group ( P<0.01),and there was no significant difference in the incidence of cere-bral infarction between the 2 groups (P>0.05). ABCD2 score combined with TCD or MRA on TIA patients with recent cerebral infarction occurred under the diagnostic curve area AUC were 0.848 and 0.654, and the difference between the two tests was statistically significant ( Z=2.43,P=0.015) . Multivariate logistic regres-sion analysis showed that hypertension,LDL≥2.6mol/L,symptom duration≥60 min were positively correla-ted with cerebral infarction formation within 7 days after TIA. Conclusion:ABCD2 score has a good predictive value for short-term cerebral infarction in TIA. Compared with TCD, ABCD2 score combined with MRA can improve the accuracy of predicting the risk of cerebral infarction.