颈动脉超声结合ABCD^(2)评分对颈动脉系统型TIA近期病情进展的预测分析

Prediction analysis of carotid ultrasound combined with ABCD^(2)score for recent disease progression of carotid systemic TIA

目的探讨颈动脉超声结合ABCD^(2)评分对颈动脉系统型短暂性脑缺血发作(TIA)近期病情进展的预测效果。方法选择2019年1月—2022年12月本院收治的260例颈动脉系统型TIA患者作为研究对象,入院后均行颈动脉超声检测及ABCD^(2)评分评估。按照发病后3个月有无进展至急性脑梗死分为进展组和未进展组。比较两组临床资料,多因素Logistic回归法分析颈动脉系统型TIA患者近期病情进展的影响因素。创建受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),分析颈动脉超声指标、ABCD^(2)评分单独及联合对颈动脉系统型TIA患者近期病情进展的预测价值。结果260例患者中,2例因患者个人原因中途退出,最终纳入258例;36例(13.95%)纳入进展组,222例(86.05%)纳入未进展组。进展组内膜中层厚度(IMT)、血管狭窄率及ABCD^(2)评分均高于未进展组(P<0.05);多因素Logistic回归分析显示,合并高脂血症(OR=1.545,95%CI:1.214~1.966)、合并心房颤动(OR=1.592,95%CI:1.170~2.166)、首次发作到治疗时间(OR=1.689,95%CI:1.095~2.604)、超敏C反应蛋白(hs-CRP)(OR=1.761,95%CI:1.282~2.419)、IMT(OR=1.887,95%CI:1.393~2.557)、血管狭窄率(OR=1.998,95%CI:1.518~2.628)及ABCD^(2)评分(OR=1.772,95%CI:1.262~2.487)均为颈动脉系统型TIA患者近期病情进展的重要影响因素(P<0.05);ROC曲线显示,IMT、血管狭窄率及ABCD^(2)评分联合预测颈动脉系统型TIA患者近期病情进展的灵敏度高于单项,AUC也高于单项(P<0.05),特异度与单项基本一致。结论颈动脉系统型TIA近期病情进展为急性脑梗死的患者颈动脉超声IMT、血管狭窄率及ABCD^(2)评分升高;合并高脂血症、合并心房颤动、首次发作到治疗时间、hs-CRP、IMT、血管狭窄率及ABCD^(2)评分均为颈动脉系统型TIA患者近期病情进展的影响因素,IMT、血管狭窄率及ABCD^(2)评分联合对颈动脉系统型TIA患者近期病情进展的预测价值高。

Objective To explore the effect of carotid ultrasound combined with ABCD2 score in predicting the recent disease progression of carotid systemic transient ischemic attack(TIA).Methods Two hundred and sixty patients with carotid systemic TIA who were admitted to our hospital from January 2019 to December 2022 were selected as the study objects.Carotid ultrasound examination and ABCD^(2)score evaluation were performed after admission.According to the progression to acute cerebral infarction 3 months after the onset of the disease,the patients were divided into the progressive group and the non-progressive group.The clinical data of the two groups were compared,and the influencing factors of the recent disease progression in patients with carotid TIA were analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curves were created,and the Areas under the ROC curve(AUC)were calculated,to analyze the predictive value of carotid ultrasound index and ABCD2 score alone and in combination in patients with carotid systemic TIA.Results Among the 260 patients,2 cases dropped out due to personal reasons,and 258 cases were finally included.36 patients(13.95%)were included in the progress group and 222 patients(86.05%)were included in the non-progress group.Intima-media thickness(IMT),vascular stenosis rate and ABCD2 score in advanced group were higher than those in non-advanced group(P<0.05).Multivariate Logistic regression analysis showed that patients with hyperlipidemia(OR=1.545,95%CI:1.214~1.966),atrial fibrillation(OR=1.592,95%CI:1.170~2.166),time from the first onset to treatment(OR=1.689,95%CI:1.095~2.604),hypersensitive C-reactive protein(hs-CRP)(OR=1.761,95%CI:1.282~2.419),IMT(OR=1.887,95%CI:1.393~2.557),vascular stenosis rate(OR=1.998,95%CI:1.518~2.628)and ABCD2 score(OR=1.772,95%CI:1.262~2.487)were important factors affecting the recent disease progression in patients with carotid TIA(P<0.05).ROC curve showed that the sensitivity of IMT,vascular stenosis rate and ABCD^(2)score combined to predict the recent disease progression of patients with carotid system TIA was higher than that of the single item,and the AUC was also higher than that of the single item(P<0.05),however,the specificity was basically consistent with that of the single item.Conclusions Carotid ultrasound IMT,vascular stenosis rate,and ABCD^(2)score of patients with carotid systemic TIA recently progressed to acute cerebral infarction are increased.Hyperlipidemia,atrial fibrillation,time from the first episode to treatment,hs-CRP,IMT,vascular stenosis rate,and ABCD^(2)score are all influencing factors for the recent progression of patients with carotid systemic TIA.The combination of IMT,vascular stenosis rate,and ABCD^(2)score has high value in predicting the recent progression of patients with carotid systemic TIA.