ABCD^2评分预测短暂性脑缺血发作后早期复发风险的价值

ABCD^2 scores predicts risk of early recurrent events after transient ischemic attack:a hospital-based case series study

目的探讨ABCD^2评分系统对短暂性脑缺血发作(transient ischemic attack,TIA)的预测价值及存在的问题。方法收集患者临床资料及磁共振弥散加权成像(difusion weighted imaging,DWI)、CT血管成像(CTangiography,CTA)的检查结果,按ABCD^2评分标准完成评分。随访TIA后7 d TIA、小卒中和大卒中的发生率,分析ABCD^2评分与TIA后短期再发事件的关系。ABCD^2评分对于TIA后短期再发事件的预测用ROC曲线(area under the receiver operating characteristic curve)表达。结果 106例TIA患者中,再发TIA 24例(22.6%),再发卒中20例(18.9%)。在TIA危险因素中,再发TIA与再发卒中两组间TIA持续时间差异有统计学意义(P=0.0 068)。ABCD^2评分对大卒中预测价值高(AUROC=0.863,95%CI:0.799～0.926,P<0.001),对小卒中和TIA预测价值低(AUROC=0.590,95%CI:0.499～0.681,P=0.057;AUROC=0.444,95%CI:0.373～0.515,P=0.172)。Cox风险分析发现,ABCD^2评分与TIA后7 d临床复发事件问具有相关性。ABCD^2评分<3与ABCD^2评分>3两组再发事件的风险比较差异有统计学意义(HR=15.98;95%CI:6.03,42.31;P<0.001)。结论 ABCD^2评分对于再发大卒中的预测价值高,可以作为急诊预测TIA患者7 d再发大卒中的有效方法。

Objective To evaluate the ABCD2 scores in predicting early recurrent events of transient ischemic attack （TIA）. Methods The clinical data of 106 patients with TIA admitted from January 2010 to December 2011 were retrospectively analyzed. And recurrent cerebrovascular events after TIA including recurrent TIA, minor stroke and major stroke were identified by face-to-face follow up. The predictive value of area under the receiver operating characteristic curve （ROC） of various parameters was evaluated. Results Of 106 patients with TIA, 24 bad a recurrent events TIA （22.6%） and 20had a recurrent stroke （ 18.9% ） within 7 days. Duration time of TIA between recurrent TIA and recurrent stroke showed significant difference （P = 0. 0 068 ）. The ABCD2 scores were highly predictive for major recurrent stroke （ area under ROC curve = 0. 863,95% CI： 0. 799 - 0. 926, P 〈 0.001 ）, weakly predictive for minor recurrent stroke and recurrent TIA （area under ROC curve = 0. 590 and 0.444,95 % CI： 0. 499 - 0. 681 and 0. 373 - 0.515, P = 0.057 and 0. 172, respectively）. The risk of any events within 7 d in patients with ABCD2scores ≥3 was significant different from that in patients with with ABCD2 scores 〈 3 （HR = 15. 98, 95% CI： 6. 03 - 42. 31, P 〈 0. 001）. Conclusion The ABCD2 score system is simple and effective method to predict major recurrent stroke after TIA within 7d.