ABCD3-Ⅰ评分联合血栓弹力图对短暂性脑缺血发作后发生急性脑梗死的预测价值

Predictive value of ABCD3-Ⅰ score combined with thromboelastography in the prediction of acute cerebral infarction after transient ischemic attack

目的 探究ABCD3-Ⅰ评分联合血栓弹力图对短暂性脑缺血发作(TIA)后发生急性脑梗死(ACI)的预测价值。方法 选取2018年3月-2021年4月江苏大学附属昆山医院收治的确诊为TIA的164例患者为研究对象,统计TIA患者发病后1周内ACI发生情况,并分为发生组(18例)和未发生组(146例)。对比发生组和未发生组临床资料。Logistic多因素回归分析影响TIA患者ACI发生的危险因素。制作受试者工作特征曲线(ROC),以曲线下面积(AUC)评价ABCD3-Ⅰ评分联合血栓弹力图对TIA患者ACI发生的预测价值。结果 TIA患者发病后1周内ACI发生率为10.98%。发生组发作持续时间、发作次数、颅内动脉狭窄程度重度占比、ABCD3-Ⅰ评分、血凝固角、最大振幅均高于未发生组(P<0.05),发生组反应时间、凝血时间则均低于未发生组(P<0.05)。Logistic回归分析结果显示,重度颅内动脉狭窄、ABCD3-Ⅰ评分、反应时间、凝血时间均为影响TIA患者ACI发生的危险因素(P<0.05)。ROC分析显示,ABCD3-Ⅰ评分、反应时间及凝血时间预测TIA患者ACI发生的最佳截断点分别为6.26分、5.35 min、1.56 min,ABCD3-Ⅰ评分、反应时间及凝血时间联合的特异度为97.95%,高于ABCD3-Ⅰ评分、反应时间及凝血时间单独进行预测的特异度,且联合预测TIA患者ACI发生的AUC为0.816,高于ABCD3-Ⅰ评分、反应时间及凝血时间单独预测TIA患者ACI发生的AUC(P<0.05)。结论 ABCD3-Ⅰ评分、血栓弹力图两者联合对TIA后发生ACI具有一定的预测价值,可作为临床评估TIA后发生ACI的重要参考指标。

Objective To explore the predictive value of ABCD3-Ⅰ score combined with thromboelastography in the occurrence of acute cerebral infarction (ACI) after transient ischemic attack (TIA).Methods A total of 164 patients diagnosed with TIA who were admitted to Kunshan Hospital Affiliated to Jiangsu University from March 2018 to April2021 were selected as the research objects.The incidence of ACI within 1 week after the onset of TIA patients was counted and divided into the occurrence group (18 cases) and No group (146 cases).The clinical data of the occurrence group and the non-occurrence group were compared.Logistic multivariate regression analysis of risk factors affecting the occurrence of ACI in TIA patients.The receiver operating characteristic curve (ROC) was prepared,and the area under the curve (AUC) was used to evaluate the predictive value of the ABCD3-Ⅰ score combined with thromboelastometry on the occurrence of ACI in TIA patients.Results The incidence of ACI in TIA patients was10.98%within 1 week after the onset of the disease.The duration of ACI attacks,number of ACI attacks,proportion of severe intracranial artery stenosis,ABCD3-Ⅰ score,blood coagulation angle,and maximum amplitude of the ACI group were all significantly higher than those of the non-ACI group (all P<0.05).The reaction time and coagulation time of the ACI group were both significantly shorter than those of the non-ACI group (both P<0.05).Logistic regression analysis showed that severe intracranial artery stenosis,ABCD3-Ⅰ score,reaction time,and clotting time were all risk factors affecting the occurrence of ACI in the TIA patients (all P<0.05).ROC analysis showed that the best cut-off points for ABCD3-Ⅰ score,reaction time,and clotting time to predict the occurrence of ACI in the TIA patients were6.26 points,5.35 min,and 1.56 min,respectively.The combined specificity of ABCD3-Ⅰ score,reaction time,and clotting time was 97.95%,significantly higher than the specificity predicted by the ABCD3-Ⅰ score,reaction time and clotting time alone,and the combined prediction of ACI in TIA patients is 0.816,significantly higher than those of ABCD3-Ⅰ score,reaction time,and clotting time alone (all P<0.05).Conclusion The combination of ABCD3-Ⅰ score and thromboelastography has a certain predictive value for the occurrence of ACI after TIA,and can be used as an important reference index for clinical evaluation of ACI after TIA.