ABCD2评分结合头颈CTA预测短暂性脑缺血发作后近期脑梗死的临床价值

目的 探讨ABCD2评分结合头颈CT血管成像（CTA）预测短暂性脑缺血发作（TIA）后7d内发生脑梗死的临床价值.方法 收集125例TIA患者临床和CTA检查资料,按Johnston提出的ABCD2评分法进行评分,分为低危（0～3分）、中危（4～5分）和高危（6～7分）3组；按CTA检查结果分为血管狭窄≥50％组和血管狭窄＜50％组.观察TIA后7d内脑梗死发生率.结果 23例（18.4％）在TIA后7d内发生脑梗死.低危组与中危组、高危组脑梗死发生率（6.9％、21.1％、37.9％）比较的差异有统计学意义（P＜0.05）.颅内外动脉狭窄≥50％组脑梗死发生率31.2％ （39/125）,显著高于动脉狭窄＜50％组（P＜0.01）.ABCD2评分＜4分、颅内外动脉狭窄≥50％组7d内脑梗死发生率20.0％（25/125）,显著高于ABCD2评分＜4分、颅内外动脉狭窄＜50％组（P＜0.01）.结论 ABCD2评分是预测TIA后7d内发生脑梗死的有效方法,进一步结合头颈CTA检查能提高预测的准确性.

The clinical value of ABCD2 score combined with CTA in prediction of cerebral infarction in the near future after transient ischemic attack

Objective To investigate the clinical value of ABCD2 score combined with cerebral and carotid artery comouted tomography angiography （CTA） in predicting the risk of cerebral infarction within 7 days after the onset of transient ischemic attack （TIA）. Methods The clinical data of 125 patients with TIA and CTA findings was analyzed. All the patients were eval uated with ABCD2 score which was proposed by Johnston, they were divided into low-risk group （0-3 points）, moderate-risk group （4-5 points）, high-risk group （6-7 points）. According to CTA findings, all the patients were divided into vascular stenosis≥50% group and vascular stenosis 〈50% group. The incidence of cerebral infarction was observed within 7 days after TIA. Results The 23 patients in 125 （18.4%） suffered cerebral infarction within 7 days after TIA. The incidence of cerebral infarction of low-risk group （6.9%） had statistically difference with that of medium risk group （21.1%） and high-risk group （37.9%） （P〈0.05）. The incidence of cerebral infarction from the group of artery stenosis≥50% （31.2%） was significantly higher than that from the group of artery stenosis 〈50% （P〈0.01）. The incidence of eerebral infarction was significantly higher in the patients with ABCD2 score less than 4 points and intra-and extra-cranial artery stenosis≥50% than those with ABCD2 score less than 4 points and intra-and extra-cranial artery stenosis ≥50% （P〈0.01）. Conclusion ABCD2 score is effective to predict risk of cerebral infarction within 7 days after TIA. The predictive accuracy can be improved by combining ABCD2 score with the findings of CTA.