磁共振弥散张量成像联合ABCD2评分、D-二聚体对短暂性脑缺血后卒中发生的预测价值

Predictive value of diffusion tensor imaging combined with ABCD2 score and D-dimer in the occurrence of stroke after transient cerebral ischemia

目的探究磁共振弥散张量成像(DTI)联合ABCD2评分、D-二聚体对短暂性脑缺血发作(TIA)后发生卒中的预测价值。方法回顾性选取2016年8月至2020年5月衡水市中医医院诊治的216例TIA患者为研究对象,依据TIA患者90 d内是否发生卒中分为卒中组(n=62)和未卒中组(n=154)。比较未卒中组、卒中组TIA患者临床资料及DTI参数各向异性分数(FA)、ABCD2评分、血清D-二聚体水平;分析DTI参数及ABCD2评分、血清D-二聚体水平对TIA患者90 d内发生卒中的评估价值;分析TIA患者90 d内发生卒中的影响因素。结果卒中组高血压病史占比、ABCD2评分、血清D-二聚体水平为79.03%、(5.23±1.74)分、(1.85±0.62)mg/L,均高于未卒中组[52.60%、(2.79±0.93)分、(1.01±0.34)mg/L],卒中组TIA患者FA为0.16±0.05,低于未卒中组(0.28±0.09),两组梗死类型分布比较,差异均有统计学意义(P<0.05)。DTI参数FA、ABCD2评分、血清D-二聚体水平预测TIA患者90 d内发生卒中的曲线下面积(AUC)分别为0.865、0.860、0.878,且FA、ABCD2评分、D-二聚体联合预测TIA患者90 d内发生卒中的AUC为0.960,敏感度为85.5%,特异度为94.2%。高血压病史、单发/多发脑梗死、ABCD2评分、D-二聚体是影响TIA患者90 d内发生卒中的危险因素(OR=2.254,95%CI:1.488~3.415;OR=2.181,95%CI:1.468~3.240;OR=2.567,95%CI:1.620~4.069;OR=2.644,95%CI:1.617~4.324;OR=2.473,95%CI:1.585~3.859,P<0.05),FA是影响TIA患者90 d内发生卒中的保护因素(OR=0.609,95%CI:0.499~0.744,P<0.05)。结论发生卒中的TIA患者DTI参数FA较低,ABCD2评分、血清D-二聚体水平较高,DTI参数FA联合ABCD2评分、血清D-二聚体可有效提高预测TIA患者90 d内发生卒中的价值,为临床提供了一定参考。

Objective To explore the predictive value of diffusion tensor imaging(DTI)combined with ABCD2 score and D-dimer(D-D)in the occurrence of stroke after transient ischemic attack(TIA).Methods From August 2016 to May 2020,216 TIA patients diagnosed and treated in Hengshui Hospital of traditional Chinese Medicine were retrospectively selected as the research objects.According to whether the TIA patients had a stroke within 90 days,they were divided into a stroke group(n=62)and a non-stroke group(n=154).The clinical data,DTI parameter fractional anisotropy(FA),ABCD2 score,and serum D-D level of TIA patients in the non-stroke group and the stroke group were compared;the value of DTI parameters,ABCD2 score,and serum D-D level in the evaluation of stroke in patients with TIA within 90 days was analyzed;the influencing factors of stroke in patients with TIA within 90 days were analyzed.Results The proportion of hypertension history,ABCD2 score and serum D-dimer level in the stroke group were 79.03%,(5.23±1.74)points,(1.85±0.62)mg/L,which were higher than those in the non-stroke group[52.60%,(2.79±0.93)points,(1.01±0.34)mg/L],the FA of TIA patients in the stroke group was 0.16±0.05,which was lower than that in the non-stroke group(0.28±0.09),there were statistically significant differences in the distribution of infarct types between the two groups(P<0.05).The area under the curve(AUC)of the DTI parameters FA,ABCD2 score,and serum DD level predicting stroke within 90 days of TIA patients was 0.865,0.860,and 0.878,respectively,the AUC of the FA,ABCD2 score and DD combined to predict the occurrence of stroke within 90 days of TIA patients was 0.960,the sensitivity was 85.5%,and the specificity was 94.2%;the history of hypertension,single/multiple cerebral infarction,ABCD2 score,D-D were risk factors that affected the occurrence of stroke in patients with TIA within 90 days(OR=2.254,95%CI:1.488~3.415;OR=2.181,95%CI:1.468~3.240;OR=2.567,95%CI:1.620~4.069;OR=2.644,95%CI:1.617~4.324;OR=2.473,95%CI:1.585~3.859,P<0.05),FA was a protective factor that affected the occurrence of stroke in patients with TIA within 90 days(OR=0.609,95%CI:0.499~0.744,P<0.05).Conclusion TIA patients with stroke have lower DTI parameter FA,and higher ABCD2 score and serum DD level.DTI parameter FA combined with ABCD2 score and serum DD can effectively improve the value of predicting stroke in TIA patients within 90 days,which providing a certain reference for the clinic.