短暂性脑缺血发作后早期卒中风险预测的评估及改良

The evaluation and improvement of early stroke prediction after transient ischemic attack

目的探讨ABCD^2评分＋低密度脂蛋白（LDL）（简称ABCD。L）在短暂性脑缺血发作（TIA）后早期卒中风险预测中的价值。方法按ABCD^2和ABCD^2L评分对绍兴市人民医院165例TIA患者分组、评分，观察各组2，7d脑梗死发生率，用ROC曲线评价两种评分法的预测价值。进一步根据两种评分危险分层，分低、中、高危三组，比较各组间卒中发生率的差异。结果TIA患者脑卒中率：2d时为13．33％；7d时为20．0％。预测2d卒中风险，ABCD^2及ABCD^2L评分的ROC曲线下面积（AUC）为0．76和0．80；预测7d卒中风险，两种评分的ROC曲线下面积为0．73和0．79。按ABCD^2评分危险分层，低、中、高危各组的脑卒中率：2d时，1．9％，14．9％，30．8％；7d时，3．8％，21．8％，46．2％（P〈0．05）。按ABCD。L评分危险分层，三组脑卒中率2d分别为0％，7．8％，31．1％；7d时脑卒中率分别为0％，12．6％，44．4％（P〈0．05）。结论ABCD^2L改良评分较ABCD^2评分更具预测准确性。其危险分层可用来筛选TIA后早期卒中的危险患者。

Objective To explore the ability of ABCD^2score ＋ Low density lipoprotein （LDL） （ABCD^2L） in predicting early stroke risk after transient ischemic attack （TIA） . Method A total of 165 TIA patients were evaluated and classified according to ABCD^2 score and ABCDZL score. The occurrences of cerebral infarction were observed at 2＇h day or 7＇h day. ROC curve was used to compare the predictive vaule of two scores. Furthermore, according to these two scores, these patients were classified into three risk groups （low, moderate and high）, observed their stroke rate , and compared the differences of three groups with X^2 test. Results The two-day risk of stroke was 13.33% and the seven-day risk of stroke was 20. 0% in 165 patients. When the occurrences of cerebral infarction were observed in two days, the area under the curves （AUC） of ABCD^2 and ABCD^2L was 0. 76 and 0. 80; observed in seven days, the AUC of two scores was 0. 73 and 0.79. According to the risk stratification of ABCD2 score, in three risk groups, the two-day risk of stroke was 1.9% , 14. 9% and 30. 8% ; the seven-day risk of stroke was 3.8% , 21.8% and 46. 2% （P 〈0. 05） . According to the risk stratification of ABCD2L score, the two-day risk of stroke was 0%, 7.8% and 31.1% ; the seven-day risk of stroke was 0%, 12. 6% and 44.4% （P〈0.05）. Conclusions The predictive accuracy of the ABCD^2L score is significantly higher than that of ABCD^2 score. Furthermore, individuals at high early risk of stroke after TIA can be identified according to the risk stratification of ABCD^2L score.