ABCD^2评分法结合房颤改良评分法在短暂性脑缺血发作后早期脑梗死风险预测中的价值

Modified ABCD^2 score in early prediction of cerebral infarction after transient ischemic attack

目的探讨ABCD^2评分法结合房颤改良评分法(ABCD^2F评分法)在短暂性脑缺血发作(TIA)患者早期脑梗死风险预测中的价值。方法对260例TIA患者,按照ABCD^2与ABCD^2F评分法分别进行评分,观察两组患者2d和7d脑梗死发生率,用ROC曲线评价2种评分方法对于脑梗死的预测价值。根据2种评分法的危险分层(低、中、高危),进一步比较两组患者脑梗死发生率的差异,并对危险因素进行多元回归分析。结果 TIA患者2d和7d脑梗死发生率分别为10.0%和16.1%。预测2d脑梗死风险,ABCD^2及ABCD^2F评分法的ROC曲线下面积分别为0.67和0.65;预测7d脑梗死风险,2种评分的ROC曲线下面积分别为0.63和0.62。对7d发生脑梗死的危险因素进行多元logistic回归分析发现,房颤是7d脑梗死的独立危险因素(P<0.05)。按ABCD^2评分法危险分层,低、中、高危各组的脑卒中发生率:2d为1.22%、12.8%、16.98%,7d为3.66%、18.40%、30.19%;按ABCD^2F评分法危险分层,低、中、高危各组的脑卒中发生率:2d为0%、12.69%、16.98%,7d为1.37%、18.66%、30.19%;两种评分法各危险分层分组间脑梗死发生率的差异均有统计学意义(均P<0.01)。结论 ABCD^2F评分具有早期脑梗死预测价值,结合房颤的危险分层更具精确性。

Objective To assess the application of modified ABCD2 score（ABCD2F）, which was supplemented with a- trial fibrillation （AF）, in early prediction of cerebral infarction after transient ischemia attack （TIA）. Methods A total of 260 TIA patients were evaluated with ABCD2 and ABCD2F scores. The occurrences of cerebral infarction within 2 and 7 clays were ob- served. Results Among 260 patients, cerebral infarction occurred in 26 cases（10.0%） within 2 d and in 42 cases（16.1%） within 7 d. The areas under curve of receiver operating characteristic curve （AUC-ROC）for ABCD2 and ABCD2F were 0.67 and 0.65 in predicting the risk of cerebral infarction within 2 d, and were 0.63 and 0.62 in predicting within 7 d, respectively. Logistic regres- sion analysis suggested that AF was an independent predictor of risk of cerebral infarction within 7 d （P〈0.05）. The incidence of cerebral infarction in patients with low, intermediate and high ABCD2 scores within 2 d and 7d was 1.22%, 12.8%, 16.98% and 3.66%, 18.40%, 30.19%, respectively （P〈0.01）. The incidence of cerebral infarction in patients of low, intermediate and high ABCD2F scored within 2 d and 7d was 0%,12.69%,16.98%and 1.37%, 18.66%,30.19%, respectively （P〈0.01）. Conclusion The ABCD2F score is more accurate than ABCD score in predicting early cerebral infarction in patients with transient ischemic at- tack.