ABCD2评分对TIA短期内进展为脑梗死风险的评估价值

Usage of ABCD2 score performance in TIA early stoke risk

目的采用ABCD2评分法结合颅内外血管检查对短暂性脑缺血发作(TIA)7 d内发生脑梗死的风险进行评估,为早期防治TIA、降低脑梗死发生率提供依据。方法 148例颈内动脉系统TIA患者进行ABCD2评分,所有患者均行颈动脉血管超声及经颅多普勒(TCD)检查,65例(44.0%)行主动脉弓—颅内CT血管成像(CTA)检查。发病7 d内行头颅MRI检查,结合临床体征诊断脑梗死。计算7 d内TIA患者脑梗死的发生率。对ABCD2评分≥4分的不同程度颅内动脉狭窄患者TIA 7 d内脑梗死的发生率进行比较。结果 148例TIA患者中,低、中、高危者分别为53、68、27例,20.3%的患者7 d内进展为脑梗死,低、中、高危者脑梗死发生率分别为1.9%(1/53)、27.9%(19/68)、37.0%(10/27),三者相比,P均<0.01。脑梗死发生率与TIA的ABCD2评分呈正相关(r=0.712,P<0.05);ABCD2评分≥4分者中,重度颅内动脉狭窄者TIA 7 d内脑梗死发生率为46.9%(15/32),明显高于正常及轻度者的16.7%(4/24),P<0.05。结论 ABCD2评分在TIA 7 d内发生脑梗死的预测方面有较好的应用价值,结合颅内血管检查,可提高对TIA短期内脑梗死发生风险预测的准确性。

Objective To make an evaluation of the incidence of cerebral infarction after transient ischemic attack （TIA） in 7 days by ABCD2 score combined with vascular screening, to provide a basis for early prevention and treatment for TIA and reduce the incidence of cerebral infarction. Methods We collected an information of 148 patients with TIA （carotid artery system） and calculated the rate of cerebral infarction caused after TIA in 7 days by ABCD2 score. All pa- tients accepted carotid artery vascular ultrasound and TCD test, among them 65 patients accepted angiography. Head MRI was adopted in all patients in 7 days of TIA to make diagnosis combined with clinical sign. Incidence of TIA in 7 days was calculated. The risks of developing cerebral infarction with ABCD2 score ≥4 but varying degrees of cerebrovascular stenosis were compared. Results A total of 148 patients were included in the study. Patients at low, moderate and high risk of early stroke were 53, 68 and 27, respectively. The risk of recurrent stroke at 7 day were 20.3%. The rate of recurrent stoke at low, moderate and high risk of early stroke were 1.9% （ 1/53）, 27.9% （ 19/68）, 37.0% （ 10/27）, P 〈0.01. The ABCD2 score was positively correlated with the rate of cerebral infarction （r =0. 712）. The rate of cerebral infarction in the TIA patients with ABCD2 score ≥4 and severe cerebrovascular stenosis was 46.9% in 7 days, and the risk of develo- ping cerebral infarction increased than that of patients with ABCD2 score ≥ 4 and mild cerebrovascular stenosis （ 16.7% ） （ P 〈 0.05 ）. Conclusion ABCD2 score is effective to predict the occurrence cerebral infarction in 7 days after TIA, and the accuracy can be improved by combining vascular screening.