ABCD^2评分法结合CTA预测TIA患者近期卒中风险的临床研究

Clinical study of ABCD^2 scoring system for prediction of short-term risk of stroke after TIA

目的探讨采用ABCD2评分法对短暂脑缺血发作(TIA)患者短期内进展为脑梗死的预测价值;评价脑血管狭窄与TIA患者脑梗死发生率及ABCD2评分之间的关系。方法按照Johnston等对TIA的ABCD2评分标准,测定98例TIA患者的评分并危险分组,观察其2、7d内脑梗死的发生率,比较各危险组之间卒中率的差异;通过CTA评估脑血管狭窄,并分为血管狭窄≥50%组与血管狭窄<50%组,分析脑血管狭窄与2、7d内脑梗死的发生率的关系,评价ABCD2评分与脑血管狭窄之间的相关性。结果 (1)评分≤3分的TIA患者有40例。2、7d发生脑梗死的例数分别为0例(0%)、2例(5%);评分为4～5分的患者46例,2、7d进展为脑梗死的例数分别为4例(8.7%)、11例(23%);评分≥6分的患者12例,2、7d进展为脑梗死的例数分别为3例(25%)、4例(33.3%)。不同ABCD2评分值的TIA患者,其脑梗死发生率差异均有统计学意义(P均<0.05)。(2)脑血管狭窄≥50%组与狭窄<50%组比较,TIA后7d内卒中发生率明显增高,且其脑梗死发生率差异有统计学意义(21.4%vs 5.6%,P=0.04)。(3)血管狭窄≥50%组与狭窄<50%组比较,中、高危的比率增高(46.4%vs 19.4%),且其比率增高有统计学意义(P=0.02)。结论 (1)ABCD2评分能够预测TIA患者2、7d内卒中发生率,是临床预测TIA短期进展为脑梗死的一种简便、有效的方法。ABCD2评分值不同的TIA患者,脑梗死的发生率不同,分值越高,发生率越高。(2)合并中重度血管狭窄的TIA患者较脑血管无明显狭窄的TIA患者更易发生脑梗死。(3)ABCD2评分与脑血管狭窄具有相关性。

Objective To investigate the value of the ABCD2 score in forecasting the risk of stroke after transient is- chemic attack （TIA）, and to evaluate the relationship between ABCD2 score and cerebrovacular stenosis of the risk of stroke after patients with TIA. Methods 98 cases of TIA patients were divided into different groups according to the score of AB- CD2 criteria termed by Johnston, their 2d ,7d rate of stroke were observed ,and the difference of each group was compared. Then we assess the predictive value of each risk factor in the score. To investigate the medical records of 64 patients with the CT angiography（ CTA ）, all patients were divided into two groups according to cerebrovascular vascular stenosis ≥ 50% or not,we analyzed the relation between cerebrovaculare vascular stenosis and the 2d and 7d rate of stroke, then we evaluated the relationship between ABCD2 score and cerebrovaculare vascular stenosis. Results Of the 40 TIA patients whose score was less than 4,0 had a stroke within 2 days （0%） ,4 within 7 days （5 % ）. Of the 46 patients with a score of 4 or 5,4 had a stroke within 2 days（8.7% ） ,11 within 7 days（23% ）. Of the 12 patients at high risk with a score of greater than 5,3 had a stoke within 2 days （ 25 % ） ,4 within 7 days （ 33.3 % ）. The incidence of cerebral infarction of TIA patients with a dif- ferent score had statistically significant differenence（ P 〈 0.05 ）. The stroke within 7 days after TIA was higher in group Ce- rebrovascular stenosis t〉50% than that in group stenosis 〈 50% （21.4% vs 5.6% , P = 0.04）. Group stenosis≥50% were more likely to have ABCD2 score I〉4 compared with group stenosis 〈 50% （46.4% vs 19.4% ,P = 0.02）. Conclusion Incidence of cerebral infarction within 2 and 7 days after presence of TIA was related to the ABCD2 score. The higher the score,the higher the incidence. The ABCD2 score is effective and simple for prediction of the short term stroke risk after TIA. The stroke within 7 days after TIA is higher in patients with cerebrovascualr stenosis ≥50%. There is a significant correlation between ABCD2 score and cerebrovascualr stenosis.