短暂性脑缺血发作患者ABCD^2评分与责任血管狭窄相关性的初步研究

The correlation between ABCD2 score and the stricture degree of criminal artery in patients with transient ischemic attack:a preliminary study

目的探讨短暂性脑缺血发作(TIA)患者ABCD2评分与责任血管狭窄的相关性,以及侧支循环对TIA预后的影响。方法回顾性研究84例TIA患者入院时的ABCD2评分及脑血管DSA影像学资料,根据ABCD2评分,分为≥4分组和<4分组;根据DSA影像学结果,分为责任血管狭窄≥50%组和<50%组,评价ABCD2评分与责任血管狭窄的相关性,以及侧支循环对TIA后2d内脑卒中风险的影响。结果①责任血管狭窄率≥50%组与<50%组比较,年龄≥60岁者所占比率高[分别为52.7%和27.6%,χ2=4.87,OR值=2.928,95%CI(1.109,7.733),P=0.027],既往有缺血性卒中史者所占比率高[分别为29.1%和6.9%,χ2=5.555,OR值5.538,95%CI(1.176,26.087),P=0.018]。②责任血管狭窄率≥50%组与<50%组比较,ABCD2评分≥4分者所占比例高[分别为45.5%和20.7%,χ2=5.001,OR值=3.194,95%CI(1.125,9.070),P=0.025]。③责任血管狭窄率≥50%组TIA患者2日内卒中发生率高于狭窄率<50%组(分别为36.4%和27.6%),但差异无统计学意义[χ2=0.658,OR值=1.500,95%CI(0.562,4.006),P=0.417]。④责任血管狭窄率≥50%组TIA患者2d内卒中风险与持续吸烟、ABCD2评分≥4分相关,侧支循环开放使2d内脑卒中风险降低,[OR值=0.179,95%CI(0.051,0.624),P=0.005]。结论①年龄及既往缺血性卒中史与血管狭窄程度相关。②ABCD2评分≥4分与责任血管狭窄≥50%相关。③责任血管狭窄率≥50%组中,持续吸烟、ABCD2评分≥4分使TIA患者2d内脑卒中风险增加;侧支循环开放使TIA患者2d内脑卒中风险降低。

Objective To discuss the relationship between ABCD2 score and the stricture degree of criminal artery in patients with transient ischemic attack （TIA） and to study the impact of collateral circulation on the prognosis.Methods The ABCD2 score on admission and the imaging materials of cerebral digital subtraction angiography （DSA） in 84 patients with TIA were retrospectively reviewed.Based on the ABCD2 score the patients were divided into two groups：group ≥ 4 and group 4.According to the stricture degree of the criminal artery determined on DSA the patients were divided into group ≥ 50% stricture and group 50% stricture.The correlation between ABCD2 score and the criminal artery stricture was analyzed,and the impact of collateral circulation on the occurrence of ischemic stroke within 2 days after TIA was evaluated.Results （1） The proportion of patients aged over 60 years in group ≥ 50% stricture was higher than that in group 50% stricture （52.7% and 27.6% respectively,P=0.027）.The percentage of patients having a previous history of ischemic stroke in group ≥ 50% stricture was higher than that in group 50% stricture （29.1% and 6.9% respectively,P=0.018）.（2） Patients in group ≥ 50% stricture were more likely to have an ABCD2 score ≥ 4 when compared to group 50% stricture （45.5% vs 20.7%,P=0.025）.（3） The incidence of ischemic stroke occurred within 2 days after TIA in group ≥ 50% stricture and group 50% stricture was 36.4% and 27.6% respectively,the difference between two groups was of no statistical significance （P=0.417）.（4） The occurrence of ischemic stroke within 2 days after TIA in group ≥ 50% stricture showed a parallel relationship with the continuing smoking as well as with ABCD2 score ≥ 4,while the presence of open collateral circulation could significantly reduce the risk of ischemic stroke occurred within 2 days after TIA （P=0.005）.Conclusion （1） Patient＇s age and previous history of ischemic stroke bear a relationship to the stricture degree of the criminal artery.（2） ABCD2 score ≥ 4 is correlated with ≥ 50% stricture degree of the criminal artery.（3） For patients in group ≥ 50% stricture,continuing smoking and ABCD2 score ≥ 4 will increase the risk of ischemic stroke occurred within 2 days after TIA,while the presence of open collateral circulation can significantly reduce the risk.