血流动力学参数联合ABCD3-Ⅰ评分对短暂性脑缺血发作患者脑卒中风险的预测价值

Predictive value of hemodynamic parameters combined with ABCD3-Ⅰscore for stroke risk in patients with transient ischemic attack

目的探讨血流动力学参数联合ABCD3-Ⅰ评分在短暂性脑缺血发作(TIA)后早期发生缺血性脑卒中(IS)风险的预测价值。方法收集2019年5月至2021年5月在解放军联勤保障部队第九八八医院神经内科就诊的TIA患者110例,根据TIA发作后7 d内结局分为7 d内IS组20例和7 d内无IS组90例,根据TIA发作后30 d内结局分为30 d内IS组31例和30 d内无IS组79例。ABCD3-Ⅰ评分低危患者15例,中危患者49例,高危患者46例。记录所有患者TIA发作时的ABCD3-Ⅰ评分及颈动脉血流动力学参数收缩期血流速度(PSV)、舒张末期血流速度(EDV)及阻力指数(RI)。比较不同等级ABCD3-Ⅰ评分患者IS发生率;使用多因素logistic回归和ROC曲线分析。结果ABCD3-Ⅰ评分低、中、高危患者7、30 d内IS发生率比较,差异有统计学意义(P=0.000)。7 d内IS组高血压、RI及ABCD3-Ⅰ评分明显高于7 d内无IS组,PSV、EDV明显低于7 d内无IS组(P<0.05,P<0.01)。30 d内IS组高血压、RI及ABCD3-Ⅰ评分明显高于30 d内无IS组,PSV、EDV水平明显低于30 d内无IS组,差异有统计学意义(P<0.01)。高血压、PSV、EDV及ABCD3-Ⅰ评分均是TIA后7 d内及30 d内发生IS的危险因素(P<0.05,P<0.01);血流动力学参数联合ABCD3-Ⅰ评分预测TIA患者7 d及30 d内发生IS的曲线下面积分别为0.929(95%CI:0.864~0.970)和0.900(95%CI:0.828~0.949),均高于单独血流动力学参数或ABCD3-Ⅰ评分预测(P<0.05)。结论血流动力学参数联合ABCD3-Ⅰ评分可用于TIA发作后脑卒中风险的评估,预测价值高于单独指标。

Objective To investigate the predictive value of hemodynamic parameters combined with ABCD3-Ⅰscore for the risk of early IS after TIA.Methods A total of 110TIA patients admitted to our hospital from May 2019to May 2021were recruited in this study.They were divided into 7-day IS group(20cases)and 7-day non-IS group(90cases)according to their outcome within 7dafter TIA,and also into 30-day IS group(31cases)and 30-day non-IS group(79cases)based on their outcome within 30dafter TIA.According to their ABCD3-Ⅰscore,there were 15 low-,49medium-,and 46high-risk patients.ABCD3-Ⅰscore and carotid hemodynamic parameters,including PSV,EDV and RI,were recorded in all patients at TIA.The incidence of IS was compared in patients with different ABCD3-Ⅰscore.Multivariate logistic regression and ROC curve analyses were used to analyze the data.Results There were statistical differences in the incidence of IS within 7and 30days among the patients with low-,medium-and high-risk ABCD3-Ⅰscores(P=0.000).The 7-day IS group had significantly larger proportion of hypertension and higher RI value and ABCD3-Ⅰscore,and lower PSV and EDV than the 7-day non-IS group(P<0.05,P<0.01).Similar results were observed in the 30-day IS group when compared with the 30-day non-IS group(P<0.01).Hypertension,PSV,EDV and ABCD3-Ⅰscore were all risk factors for IS within 7and 30dafter TIA(P<0.05,P<0.01).The areas under curve of hemodynamic parameters combined with ABCD3-Ⅰscore were 0.929(95%CI:0.864-0.970)and 0.900(95%CI:0.828-0.949)in the diagnosis of IS in TIA patients within 7and 30days,respectively,which were higher than those of hemodynamic parameters alone or ABCD3-Ⅰscore alone(P<0.05).Conclusion Hemodynamic parameters combined with ABCD3-Ⅰscore can be used to assess the risk of stroke after TIA,and have higher predictive value than these indicators alone.