ESRS评分结合弥散加权成像对TIA后继发脑梗死风险的预测价值

The Value of ESRS Score Combined with Diffusion Weighted Imaging in Predicting the Risk of Secondary Cerebral Infarction after TIA

目的:探讨Essen卒中风险评分量表(ESRS)结合磁共振弥散加权成像(DWI)对短暂性脑缺血发作(TIA)后继发脑梗死风险的预测价值。方法:选取2016年1月至2018年1月在本院接受治疗的TIA患者176例为研究对象,均行ESRS评估及DWI检查。依据ESRS评分将患者分为低危组(125例)和高危组(51例),同时依据DWI检查结果将研究对象分为DWI阴性组(118例)和DWI阳性组(58例),随访记录研究对象7 d内是否发生脑梗死,比较低危组、高危组,DWI阴性组、DWI阳性组TIA患者7 d内脑梗死发生率。采用四格表分析ESRS评分联合DWI检查对TIA患者7d内是否发生脑梗死的诊断价值。分析DWI检查结果与TIA患者基本资料的关系,并采用logistic回归模型分析影响TIA患者7d内发生脑梗死的因素。结果:随访结果显示,176例研究对象7 d内有29例发生脑梗死,发生率为16.48%;高危组与低危组相比,TIA患者7 d内脑梗死发生率更高(P<0.05);DWI阳性组与DWI阴性组相比,TIA患者7d内脑梗死发生率更高(P<0.05)。ESRS评分联合DWI检查诊断TIA患者7d内发生脑梗死的灵敏度、特异度、准确度分别为89.66%、75.51%、77.84%,灵敏度、准确度相比单一指标均有所提高。DWI阳性组年龄,高血压、糖尿病、吸烟史占比与DWI阴性组间均无明显差异(P>0.05),但TIA发作次数3=3、症状持续时间≥1h、心房颤动占比及低密度脂蛋白水平均高于DWI阴性组(P<0.05);多因素logistic回归分析结果表明,TIA发作次数、症状持续时间、心房颤动、低密度脂蛋白均是影响TIA患者7 d内脑梗死发生的因素(P<0.05)。结论:ESRS评分联合DWI检查对TIA短期继发脑梗死有一定预测价值,可为评估TIA患者临床预后提供参考依据。

Purpose:To explore the predictive value of Essen stroke risk score(ESRS)combined with diffusion weighted imaging(DWI)in the risk evaluation of cerebral infarction after transient cerebral ischemic attacks(TIA).Methods:A total of 176 TIA patients who were treated in our hospital from January 2016 to January 2018 were selected as the study subjects.ESRS score and DWI were performed.According to the ESRS score,the patients were divided into low-risk group(125 cases)and high-risk group(51 cases);according to the results of DWI examination,the subjects were divided into DWI negative group(118 cases)and DWI positive group(58 cases).All the patients were followed up and recorded whether cerebral infarction occurred within 7 days.The incidence rate of cerebral infarction in TIA patients in low-risk group,high-risk group,DWI negative group and DWI positive group were compared within 7 days;the diagnostic values of ESRS and DWI in TIA patients with cerebral infarction within 7 days were analyzed by four grid table;the relationship between DWI results and TIA patients'basic data was analyzed,and the logistic regression model was used to analyze the influencing factors of TIA patients with cerebral infarction within 7 days.Results:The follow-up results showed that 29 of 176 subjects had cerebral infarction within 7 days,and the incidence rate was 16.48%;the incidence rate of cerebral infarction within 7 days in high-risk group was higher than that in low-risk group(P<0.05);the incidence rate of cerebral infarction within 7 days in DWI positive group was higher than that in DWI negative group(P<0.05).The sensitivity,specificity and accuracy of ESRS combined with DWI in the diagnosis of TIA patients with cerebral infarction within 7 days were 89.66%,75.51% and 77.84%,respectively,and the sensitivity and accuracy were improved when compared with single index.There was no significant difference in age,hypertension,diabetes mellitus and smoking history between the DWI negative group and DWI positive group(P>0.05),while the percentage of TIA attack times≥3,duration of symptoms≥1 h,atrial fibrillation and the level of low-density lipoprotein were higher in DWI positive group than that in DWI negative group(P<0.05);the results of multivariate logistic regression analysis showed that the times of TIA attack,symptom duration,atrial fibrillation and low density lipoprotein were all the factors influencing the occurrence rate of cerebral infarction of TIA patients within 7 days(P<0.05).Conclusions:ESRS combined with DWI has a certain predictive value for short-term secondary cerebral infarction in TIA patients,which can provide a reference for evaluating the clinical prognosis of TIA patients.