颈动脉超声联合ABCD3-Ⅰ评分及血清miR-146a预测短暂性脑缺血发作后继发脑梗死的临床价值

Clinical value of carotid ultrasound combined with ABCD3-Ⅰscore and serum miR-146a in predicting secondary cerebral infarction after transient ischemic attack

目的探讨颈动脉超声联合ABCD3-Ⅰ评分及血清miR-146a预测短暂性脑缺血发作(TIA)后继发脑梗死的临床应用价值。方法选取我院收治的90例TIA患者,根据TIA后30 d内是否继发脑梗死分为脑梗死组42例和非脑梗死组48例,比较两组临床资料、颈动脉狭窄程度、ABCD3-Ⅰ评分及血清miR-146a的差异。采用Logistic回归分析筛选TIA后继发脑梗死的独立危险因素;绘制受试者工作特征(ROC)曲线分析颈动脉狭窄程度、ABCD3-Ⅰ评分、血清miR-146a单独及联合应用预测TIA后继发脑梗死的诊断效能。结果脑梗死组与非脑梗死组颈动脉狭窄程度、ABCD3-Ⅰ评分和血清miR-146a比较,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,颈动脉狭窄程度、ABCD3-Ⅰ评分和血清miR-146a均为TIA后继发脑梗死的独立危险因素(OR=2.807、2.680、2.762,均P<0.05)。ROC曲线分析显示,颈动脉狭窄程度、ABCD3-Ⅰ评分和血清miR-146a预测TIA后继发脑梗死的曲线下面积分别为0.892、0.854和0.889,其联合应用的曲线下面积为0.925。结论颈动脉超声联合ABCD3-Ⅰ评分及血清miR-146a在预测TIA后继发脑梗死中具有较好的临床应用价值。

Objective To explore the clinical application value of carotid ultrasound combined with ABCD3-Ⅰscore and serum microRNA-146a(miR-146a)in predicting secondary cerebral infarction(CI)after transient ischemic attack(TIA).Methods A total of 90 patients with TIA admitted to our hospital were enrolled.According to presence or absence of secondary CI within 30 d after TIA,they were divided into CI group(42 cases)and non-CI group(48 cases).The clinical data,severity of carotid stenosis,ABCD3-Ⅰscore and serum miR-146a between the two groups were compared.The independent risk factors of secondary CI after TIA were screened by Logistic regression analysis.The predictive efficacy of ABCD3-Ⅰscore,carotid stenosis and serum miR-146a for secondary CI after TIA alone and in combination were analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences in the severity of carotid stenosis,ABCD3-Ⅰscore and serum miR-146a between CI group and non-CI group(all P<0.05).Logistic regression analysis showed that the severity of carotid stenosis,ABCD3-Ⅰscore and serum miR-146a were independent risk factors of secondary CI after TIA(OR=2.807,2.680,2.762,all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the severity of carotid stenosis,ABCD3-Ⅰscore and serum miR-146a for predicting secondary CI were 0.892,0.854 and 0.889,respectively,and the AUC of combined application was 0.925.Conclusion Carotid ultrasound combined with ABCD3-Ⅰscore and serum miR-146a have a good predictive value for secondary CI after TIA.