评价ABCD2评分+颈动脉硬化程度评分预测短暂性脑缺血发作后早期(7d)卒中风险价值

Predictive value of carotid atherosclerosis score combined with ABCD2 score on early cerebral infarction after transient ischemic attack

目的：探讨采用ABCD2评分联合颈动脉硬化程度评分预测短暂性脑缺血发作后早期（7 d）进展为急性脑梗死的风险,并与ABCD2评分方法进行比较。方法：回顾160例首发症状为颈内动脉系统短暂性脑缺血发作患者,均进行ABCD2评分和颈动脉硬化程度评分,并对联合评分法和两种单独的评分方法进行统计分析,观察7 d内脑梗死的发生率,比较各种方法预测价值。结果：本研究160例短暂性脑缺血发作患者中一周内共有34例发生脑梗死,脑梗死的进展率为21.3%,ABCD2≥4分组7 d内脑梗死的发生率27.3%,明显高于ABCD2~4分组（P〈0.05）。颈动脉硬化程度评分为2分组患者7 d内脑梗死的发生率为42%,高于0~1分组（P〈0.05）。A B CD 2评分联合颈动脉硬化程度评分预测短暂性脑缺血患者7 d内脑梗死发生的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为94.1%、90.5%、91.3%、72.7%、98.3%,均高于两者的单一评分。预测7 d内脑梗死的发生风险时：A BCD2评分联合颈动脉硬化程度评分曲线下面积为0.874,大于A BCD2评分的0.817和颈动脉硬化评分的0.739。结论：ABCD2评分联合颈动脉硬化程度评分对短暂性脑缺血发作后短期进展为脑梗死的预测价值高于ABCD2评分方法,并可能成为一种新的短暂性脑缺血发作患者危险分层工具和预测转归的有效手段。

Objective： To investigate predictive value of carotid atherosclerosis score combined with ABCD2 score on early cerebral infarction after transient ischemic attack, meanwhile compared it with the ABCD2 score. Methods： A total of 160 TIA patients of internal carotid artery system were selected, and all of them received ABCD2 score and carotid atherosclerosis score. Joint score and two separate score method were statistically analyzed. The incidence of cerebral infarction were observered in 7 days. The incidence of cerebral infarction was compared in patients withdifferent score. Results： In this study, there are 34 TIA patients with cerebral infarction, the incidence of cerebral infarction of TIA patients was 21. 4%, the incidence of cerebral infarction of patients with equal or over 4 points of ABCD2 score was 27.3%, significantly higher than that of patients with below 4 points（P〈0.05）, the incidence of cerebral infarction of patients with equal 2 points of carotid atherosclerosis score was 42%, significantly higher than that of patients with equal or below 1 points（P〈0.05）. Degree of sensitivity, specific, accuracy, positive predictive value and negative predictive value of carotid atherosclerosis score combined with ABCD2 score to predict early cerebral infarction after transient ischemic attack was 94.1%, 90.5%, 91.3%, 72.7%, 98.3% respectively, significantly higher than two separate score method. Predict the occurrence of cerebral infarction risk within 7 days： the area under curve of carotid atherosclerosis score combined with ABCD2 score were 0.874, it was higher than 0.817 of ABCD2 score and 0.739 of carotid atherosclerosis score. Conclusion： The predicted value after TIA for short-term progress of cerebral infarction, carotid atherosclerosis score combined with ABCD2 score was higher than ABCD2 score method, and may become a new and effective means of risk stratification tool TIA and prediction outcome.