ABCD3-I评分预测短暂性脑缺血发作患者早期卒中风险的临床价值

Clinical value of ABCD3-I score in the prediction of early stroke risk in patients with transient ischemic attack

目的：评价ABCD3-I评分法对短暂性脑缺血发作（TIA）后早期卒中风险的预测价值。方法连续纳入2010年1月—2012年12月入住商丘市第一人民医院神经内科的TIA患者136例，收集患者的一般临床资料、病史及影像学检查结果，观察90 d内卒中发生率，对TIA后发生卒中风险进行ABCD2、ABCD3-I评分。采用Logistic回归分析方法分析影响TIA后早期卒中发生的危险因素，采用受试者工作特性曲线下面积（AUC）比较两种评分的预测价值。结果在纳入的136例TIA患者中，TIA后90 d内发生脑梗死19例（14.0％），无死亡及出血性卒中。多因素回归分析结果显示：TIA发作持续时间≥60 min（OR＝1.060，95％CI：1.012～1.112）是TIA后早期进展为卒中的独立危险因素（P＜0.05）。ABCD2评分模型危险分层低、中、高危组90 d内卒中发生率分别为5.6％（4／72）、18.5％（10／54）、50.0％（5／10），ABCD3-I评分模型危险分层低、中、高危组90 d内卒中发生率分别为0、7.1％（6／84）、52.0％（13／25），ABCD3-I与ABCD2评分模型危险分层低、中、高危组90 d卒中发生率差异有统计学意义（P＜0.01）。ABCD3-I评分 AUC为0.839（95％CI：0.766～0.896），明显高于ABCD2 AUC的0.783（95％CI：0.704～0.849；P＜0.01）。结论 ABCD3-I评分法能有效预测TIA后早期卒中风险，其准确性优于ABCD2评分。

Objective To evaluate the predictive value of ABCD3-I score for early stroke risk after transient ischemic attack （TIA）. Methods A total of 136 consecutive patients with TIA admitted to the Department of Neurology,the First Hospital of Shangqiu from January 2010 to December 2012 were enrolled. The clinical data,medical history and image findings of the patients were collected. The incidence of stroke was observed within 90 days. The occurrence of stroke risk after TIA were scored with the ABCD2 and ABCD3-I. Logistic regression analysis was used to analyze the impact of risk factors for early stroke after TIA. The area under the curve （AUC）of receiver operating characteristic was used to compare the predictive values of the two kinds of scores. Results Of the 136 eligible patients with TIA,19 cases （14. 0%）had cerebral infarction within 90 days after TIA. There were no death and hemorrhagic stroke. The results of multivariate regression analysis showed that the duration of TIA≥60 min （OR,1. 060,95%CI 1. 012-1. 112）was an independent risk factor for early progressing stroke after TIA （P〈0. 05）. In the ABCD2 scoring model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 5. 6%（4/72）,18. 5%（10/54）,and 50. 0%（5/10）,respectively. In the ABCD3-I score model for risk stratification of low-,moderate-,high-risk groups,the incidences of stroke within 90 days were 0,7. 1%（6/84）,and 52. 0%（13/25）,respectively. In the low-,moderate-,high-risk groups,there were significant differences in the incidences of stroke in 90 days between the ABCD3-I and ABCD2 scoring models （P〈0.01）. The AUC of ABCD3-I score （0. 839,95%CI 0. 766-0. 896）was higher than that of ABCD2 score＆amp;nbsp;（0.783,95%CI 0. 704-0. 849;P〈0. 01）. Conclusion The ABCD3-I score may effectively predict the risk of early stroke after TIA,and its accuracy is better than ABCD2 score.