ABCD^2评分结合扩散加权成像、头颈部CT血管成像对短暂性脑缺血后发生脑梗死的预测价值

ABCD^2 Score Combined with Diffusion Weighted Imaging and CT Angiography in Predicting Cerebral Infarction After Transient Ischemic Attack

目的采用ABCD2评分量表对短暂性脑缺血发作(TIA)患者进行评分,分析ABCD2评分结合磁共振扩散加权成像(DWI)和头颈部CT血管成像(CTA)对于TIA后7 d发生脑梗死的预测价值。资料与方法 80例TIA患者行DWI和CTA检查,采用ABCD2评分对TIA患者进行评分及危险度分层,比较不同危险度TIA患者脑梗死的发生率以及DWI阳性结果与ABCD2评分中危险因素的关系,并分析DWI与ABCD2分层模型对于TIA的预测能力,以及两者结合预测TIA后进展为脑梗死的能力。探讨动脉管腔狭窄程度与TIA患者发生脑梗死的关系。结果 ABCD2分层高危组在TIA后7 d脑梗死发病率显著高于低危组(χ2=7.744,P<0.01)。DWI阳性患者具有ABCD2各危险因素的概率明显高于DWI阴性患者(P<0.01)。ABCD2分层对于TIA患者预测能力的OR值为3.638(95%CI 1.059~12.498,P<0.05);DWI分层对于TIA患者预测能力的OR值为4.609(95%CI 1.187~17.772,P<0.05)。ABCD2分层模型及ABCD2分层联合DWI对TIA的预测能力无显著差异(P>0.05)。TIA重度狭窄组7 d后脑梗死发生率显著高于正常或轻度狭窄组(χ2=4.292,P<0.05)。结论 ABCD2评分结合DWI、CTA对于TIA后短期内脑梗死发生率具有较高的预测价值。

Purpose To analyze the predictive value ofABCD2 score combined with magnetic resonance diffusion weighted imaging （DWI） and head and neck CT angiography （CTA） in cerebral infarction after 7 days of transient ischemic attack （TIA）. Materials and Methods Eighty patients with TIA underwent DWI and CTA, and were stratified according to ABCD2 score. The incidence of cerebral infraction of TIA patients was analyzed in terms of risk stratification and the relationship of positive DWI results and ABCD2 risk factors was also explored. Then the value of DWI and ABCD2 stratification model was discussed in predicting TIA and cerebral infraction; and the relationship between the degree of artery stenosis and incidence of cerebral infarction in patients with TIA was also explored. Results The incidence of cerebral infarction at 7 d was significantly higher in high risk group than that in low risk group （χ^2=7.744, P〈0.01）. The ABCD： risk factors of patients with DWI positive results were significantly higher than those with DWI negative results （P〈0.01）. The OR value of predictive ability of ABCD： stratification for patients with TIA was 3.638 （95% CI 1.059-12.498, P〈0.05）： the OR value of DWl stratification of predictive ability for patients with TIA was 4.609 （95% CI 1.187-17.772, P〈0.05）. The ABCD： hierarchical model and the combined model of ABCD-＂ stratification and DWl checks showed no significant difference in T1A prediction （P〉0.05）. The incidence of cerebral infraction in TIA patients with severe stenosis was significantly higher than that in those with normal or mild stenosis at 7 d （χ^2=4.292, P〈0.05）. Conclusion The ABCD2 score combined with DWl and head and neck CTA has rather high value in predicting cerebral infhrction incidence during a short term after TIA.