ABCD^3-I评分系统对短暂性脑缺血发作后发生卒中的预测价值研究

Evaluation of ABCD^3-I Score for Predicting Ischemic Stroke after Transient Ischemic Attack

目的验证由ABCD2评分系统改进而来的ABCD3-I评分系统对短暂性脑缺血发作(TIA)后7 d及90d内发生卒中的预测价值。方法回顾性收集2008年1月—2012年6月在浙江医院神经内科住院的符合入选标准的TIA患者131例,对其临床、影像学表现及预后等进行分析,通过ROC曲线下面积(AUC)评估ABCD3-I评分对TIA后发生卒中的预测价值,并应用Logistic回归分析相关危险因素。结果 131例TIA患者中9例(6.9%)于7 d内发生卒中,17例(13.0%)于90 d内发生卒中。ABCD2评分系统预测7 d内发生卒中的AUC为0.719〔95%CI(0.573,0.864),P=0.029〕;ABCD2评分系统预测90 d内发生卒中的AUC为0.635〔95%CI(0.512,0.758),P=0.073〕。ABCD3-I评分系统预测7 d内发生卒中的AUC为0.768〔95%CI(0.609,0.927),P=0.007〕,与ABCD2评分系统比较差异无统计学意义(Z=0.447,P=0.655)。ABCD3-I评分系统预测90 d内发生卒中的AUC为0.807〔95%CI(0.702,0.911),P=0.000〕,与ABCD2评分系统比较差异有统计学意义(Z=2.089,P=0.037)。磁共振弥散加权成像(MR-DWI)高信号〔OR=4.086,95%CI(1.271,13.136),P=0.018〕及颈内动脉狭窄〔OR=3.825,95%CI(1.024,14.293),P=0.046〕是TIA后90 d内发生卒中的危险因素。结论 ABCD3-I评分系统是一个能预测TIA后7 d和90 d内发生卒中风险的良好工具。与ABCD2评分系统相比该评分能更好地预测TIA后远期发生卒中的风险,对TIA患者进行MR-DWI及血管影像学的检查有助于评估远期内发生卒中的风险。

Objective To validate the prognostic value of ABCD^3-I score improved from the ABCD^2score in 7-day and 90-day stroke risk after TIA.Methods 131 patients presented with TIA hospitalized in neurology department of Zhejiang Hospital from January 2008 to June 2012 were retrospectively studied,and the clinical manifestations,imaging findings and possible outcome and so on were analyzed.The predictive ability of ABCD^3-I score was assessed by calculating the area under the ROC curve.Logistic regression analysis was used to analyze some related risk factors.Results 9（6.9%） out of 131 patients suffered from stroke in 7 day after TIA,and 17（13.0%） in 90 days.The area under the ROC curve（AUC） in 7-day stroke of ABCD^2score system was 0.719 〔95% CI（0.573,0.864）,P = 0.029〕,and the AUC in 90-day stroke was 0.635 〔95% CI（0.512,0.758）,P = 0.073〕.Meanwhile,the AUC in 7-day stroke of ABCD^3-I system was 0.768 〔95% CI（0.609,0.927）,P = 0.007〕,which had no significant difference with ABCD^2score（Z = 0.447,P = 0.655）.The AUC in 90-day was 0.807 〔95% CI（0.702,0.911）,P = 0.000〕and it had a higher sensitivity in prediction of 90-day stroke compared with ABCD^2score system（Z = 2.089,P = 0.037）.High signal of MR-DWI 〔OR = 4.086,95% CI（1.271,13.136）,P = 0.018〕and carotid artery stenosis≥50% 〔OR = 3.825,95% CI（1.024,14.293）,P = 0.046〕were the risk factors for 90-day stroke after TIA.Conclusion ABCD^3-I score was a better tool to predict the stroke risk in 7-day and 90-day after TIA.It can predict the long-term stroke risk much better than ABCD^2 score.Carrying out MR-DWI and some imaging examinations on TIA patients can help assess the long-term risk of stoke.