ADCD^2评分对TIA后短期内脑梗死风险的预测价值评价

Prognostic value of the ADCD^2 score for stroke after transient ischemic attack

目的评价ADCD2模型对TIA患者短期内进展为脑梗死的预测价值。方法按照ADCD2预测模型对TIA患者进行评分和危险分层,观察2d、7d脑梗死发生率,与模型预测率进行比较,评估该模型对患者2d、7d内卒中预测能力,分析不同危险分层与脑梗死风险的相关趋势。结果 286例TIA患者中脑梗死总发生率为30.8%,低危组117例,2d及7d内脑梗死发生率为分别为4.3%、17.9%,中危组92例,分别为12%、19.6%,高危组77例,分别为18.2%、24.7%;ADCD2模型2d内预测AUC为0.698[95%CI 0.605～0.791,P<0.05];7d内AUC为0.612[95%CI 0.534～0.691,P<0.05];与原始模型预测比较,2d、7d内低、中、高危险组RR均小于1,2d内分别为0.2、0.45、0.43,7d内分别为0.1、0.33、0.47;χ2趋势检验2d、7d分别为χ2=145.5和χ2=76.1(P<0.001)。结论 ADCD2评分模型可用于预测TIA后短期内脑梗死发生风险,且风险性随评分升高而增高;与原始模型比较,ADCD2应用于中国人群可能存在对TIA后脑梗死风险评估不足。

Objective To validate the predictive value of the ADCD2 model on short-term stroke risk after TIA.Methods Observed number of strokes was compared with the original derived model of ADCD2,areas under the ROC（AUC）were calculated for 2 and 7 days respectively,trend in risk across the three ABCD 2 risk strata were test by Chi-square.Result 286 patients included 30.8%experienced a stroke,117 in low risk group,rate of stroke observed for 2 days and 7 days was 4.3%and 17.9%;92 in moderate risk group,12%and 19.6%;77 in high risk,18.2% and 24.7%.AUC of ADCD2 for 2 days was 0.698[95%CI 0.605~0.791,P0.05];AUC for 7days was 0.612[95%CI 0.534~0.691,P〈0.05].Compared with the orginal model,RRs for both 2 days and 7days were under 1.Chi-square for 2days and7 days were 145.5 and 76.1（P〈0.001）.Conclusions ADCD2 may be clinically useful in identifying TIA patients at raised risk of stroke after TIA,but it may under-predict risk of stroke for both 2 and 7 days compared with the original model.