ABCD3评分结合血浆同型半胱氨酸测定评估短暂性脑缺血后短期卒中风险

Detection and review of short-term stroke risk after transient ischemic attack with ABCD3 scoring method combining homocysteine

目的探讨ABCD3结合血浆同型半胱氨酸（homocystine,Hcy）评估短暂性脑缺血（transient ischemic attack,TIA）后短期卒中风险的价值。方法入选2012年1月~2015年1月在上海市第六人民医院金山分院神经内科治疗的285例TIA患者为研究对象,采用三种评分方法,即ABCD2评分法、ABCD3评分法及ABCD3联合Hcy评分进行评分及危险分层。记录TIA后2 d内和7 d内脑卒中事件的发生率。绘制研究对象特征曲线（receiver operating characteristic,ROC）,即ROC曲线,观察曲线下面积（area under the curve,AUC）,评估ABCD2、ABCD3及ABCD3联合Hcy评分三种评分方法的价值。结果ABCD2评分法、ABCD3评分法及ABCD3联合Hcy三种评分方法TIA后2 d内的发生卒中的风险AUC及95%的可信区间（CI）分别为：0.702（0.579~0.818）、0.783（0.671~0.895）、0.846（0.751~0.935）,而ABCD3联合Hcy的AUC为最大,三种评分方法AUC相比差异具有统计学意义（P〈0.05）;ABCD2评分法、ABCD3评分法及ABCD3联合Hcy三种评分方法TIA后7 d内的发生卒中的风险AUC及95%的可信区间（CI）分别为：0.757（0.662~0.849）、0.833（0.746~0.913）、0.873（0.805~0.951）,而ABCD3联合Hcy的AUC面积为最大,三种评分方法AUC相比差异具有统计学意义（P〈0.05）;285例TIA患者7 d内发展成卒中患者的比例为28.8%,其中高危组、中危组、低危组脑卒中的发生率分别为55.8%、21.9%、3.8%,差异有统计学意义（P〈0.05）。结论 ABCD2评分法、ABCD3评分法及ABCD3联合Hcy三种评分方法对于评估TIA后短期卒中风险的均具有一定的临床价值,对TIA后短期卒中风险的评估,ABCD3联合Hcy预测卒中风险的准确性优于ABCD2评分和ABCD3评分,值得临床推广应用。

Objective To discuss the review value of ABCD3 scoring method combining homocysteine （Hcy, ABCD3＋Hcy） to the risk of short-term stroke after transient ischemic attack （TIA）. Methods TIA patients （n=285） were chosen from Jan. 2012 to Jan. 2015, and scored for risk stratification by applying ABCD2 scoring method （ABCD2）, scoring method （ABCD3） and ABCD3＋Hcy. The incidence of stroke was recorded within 2 d and within 7 d after TIA. The receiver operating characteristic curve （ROC） was drawn and area under curve （AUC） was observed. The values of ABCD2, ABCD3 and ABCD3＋Hcy were reviewed. Results AUC of stroke risk within 2 d after TIA was 0.702 （95% CI： 0.579~0.818） in ABCD2, 0.783 （95% CI： 0.671~0.895） in ABCD3 and 0.846 （95% CI： 0.751~0.935） in ABCD3＋Hcy, and AUC was the largest in ABCD3＋Hcy （P〈0.05）. AUC of stroke risk within 7 d after TIA was 0.757 （95% CI： 0.662-0.849） in ABCD2, 0.833 （95% CI： 0.746~0.913） in ABCD3 and 0.873 （95% CI： 0.805~0.951） in ABCD3＋Hcy, and AUC was the largest in ABCD3＋Hcy （P〈0.05）. The percentage of stroke within 7 d after TIA was 28.8% among 285 cases, and incidence rate of stroke was 55.8% in high-risk group, 21.9% in mid-risk group and 3.8% in low-risk group （P〈0.05）. Conclusion ABCD2, ABCD3 and ABCD3＋Hcy have some clinical values in reviewing the risk of short-term stroke after TIA, and veracity of ABCD3＋Hcy is higher than other 2 methods in predicting stroke risk, which is worth clinical application.