ABCD^3评分评价短暂性脑缺血发作患者早期发生脑梗死的风险

Validation of ABCD^3 Score in Identifying Transient Ischemic Attack Patients at Early Risk of Cerebral Infarction

目的探讨短暂性脑缺血发作(transient ischemic attacks,TIA)短期内进展至脑梗死的危险因素,并评价AB-CD3评分系统临床判断患者TIA后早期高危发生脑梗死的有效性。方法回顾性统计126例TIA患者缺血性脑血管病相关的危险因素和7d内脑梗死的发生率,并对其进行ABCD3评分。结果 TIA发生后7d脑梗死的发生率为10.3%。糖尿病(OR4.28,95%CI1.48～12.30,P=0.023)、7d内TIA发作超过2次(OR6.29,95%CI 2.31～17.12,P<0.001)、同侧颈动脉狭窄≥50%(OR6.48,95%CI2.25～19.49,P<0.001)、症状持续超过60min(OR4.58,95%CI1.62～12.94,P=0.015)是TIA短期内进展至脑梗死独立的危险因素;ABCD3评分为0～3分的TIA患者脑梗死的发生率为2.3%;ABCD3评分为4～5分的TIA患者脑梗死的发生率为7.4%;ABCD3评分为6～7分的TIA患者脑梗死的发生率为15.6%;ABCD3评分为8～9分TIA患者脑梗死的发生率为21.7%,趋势性检验P<0.001。结论 ABCD3评分对TIA患者短期内进展为脑梗死的危险性有一定的预测价值,TIA患者ABCD3评分值越高,短期内进展为脑梗死的概率相对越高。

Objective To study the risk factors for transient ischemic attack（TIA）to cause early cerebral infarction in a short period,and to evaluate the predictive value of ABCD3 scores to identify TIA patients with high risks of early cerebral infarction.Methods 126 TIA patients were retrospectively analyzed for related risk factors of ischemic cerebrovascular disease and for the incidence rate of cerebral infarction in 7 days.And the ABCD3scores were computed for the patients.Results The 7-day risk of cerebral infarction in this case series（n=126）was 10.3%.Diabetes mellitus（OR 4.28,95% CI 1.48-12.30,P=0.023）,two or more TIAs in 7 days（OR 6.29,95% CI 2.31-17.12,P0.001）,50% or more in degree of ipsilateral carotid stenosis（OR 6.48,95% CI 2.25-19.49,P0.001）,and 60 min or more in duration of symptoms（OR 4.58,95%CI 1.62-12.94,P=0.015）were identified as independent risk factors of cerebral infarction in 7 days.The ABCD3 score was highly predictive for the risks of stroke in 7 days（ABCD3=0 to 3：2.3%,ABCD3=4 to 5：7.4%,ABCD3=6 to 7：15.6%,ABCD3=8 to 9：21.7%,P for trend0.001）.Conclusion The ABCD3 score can be used to predict risks of early cerebral infarction in TIA patients,and ABCD3 score has a positive correlation with the likelihood of early cerebral infarction.