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短暂性脑缺血发作(transient ischemic attack,TIA)是由脑、脊髓或视网膜缺血所引起的短暂性神经功能障碍,不伴有急性梗死[1]。TIA是急性缺血性脑血管病的高危因素,TIA病人发作后发生缺血性卒中的风险显著增高,4%~20%的TIA病人会在90 d内发生脑卒中,其中大约有一半的卒中发生在TIA后2 d内[2]。规范化的危险分层及早期临床评估,有益于降低早期卒中复发高风险。因此,亟待需要评价TIA病人发作后早期卒中风险预测的量表作为评价体系。目前,以ABCD评分系统应用最为广泛,ABCD评分系统常用的有ABCD2、ABCD3、ABCD3-Ⅰ等3种评分方法。本研究拟采用上述3种评价方式对TIA病人进行评估,同时记录TIA病人发作后7 d内发生新发脑梗死的比例,并分析这些评分对TIA后7 d内继发脑梗死风险的预测价值。
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研究发现,150例TIA病人一周内新发脑梗死的发生率为33.3%(50/150)。2组研究对象在性别、年龄、BMI上差异均无统计学意义(P>0.05);在高血压、糖尿病、冠心病、高脂血症史、脑血管病、糖化血红蛋白和低密度脂蛋白等脑血管病危险因素方面差异均无统计学意义(P>0.05),而在吸烟和饮酒史方面脑梗死组均高于非脑梗死组(P<0.05)(见表 1)。
分组 n 年龄/岁 男 女 BMI/
(kg/m2)高血压 糖尿病 冠心病 高脂
血症脑血
管病吸烟 饮酒 糖化血红
蛋白/%同型半胱
氨酸/(μmol/L)尿酸/
(μmol/L)低密度脂
蛋白/(mmol/L)新发脑梗死组 50 59.6±12.9 35 15 23.7±3.0 34 16 2 44 9 32 19 6.4±1.7 20.1±12.2 318.8±87.0 2.69±0.8 非脑梗死组 100 60.7±13.2 78 22 22.9±3.5 63 25 12 77 16 43 20 6.2±1.2 16.7±9.7 342.0±89.4 2.7±0.8 χ2 — -0.48* 1.15 -1.80* 0.37 0.82 1.66 2.59 0.1 5.88 5.61 0.74△ 1.85* 1.51* 0.07* P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05 >0.05 *示t值; △示t′值 表 1 2组TIA病人的一般人口学及脑血管危险因素比较(n)
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与非脑梗死组比较,新发脑梗死组的3种不同的ABCD系统的评分结果均升高(P<0.05~P<0.01)(见表 2)。
分组 n ABCD2 ABCD3 ABCD3-Ⅰ 新发脑梗死组 50 3.7±1.3 5.0±1.7 7.2±1.9 非脑梗死组 100 3.2±1.5 4.2±1.8 4.3±1.9 t — 2.01 2.61 8.81 P — <0.05 <0.01 <0.01 表 2 2组TIA病人3种评分系统评分的比较(x±s; 分)
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除ABCD2评分外,随着ABCD3、ABCD3-Ⅰ评分分值的升高,7 d内继发脑梗死率不断增加(P<0.01)(见表 3)。
分组 ABCD2 ABCD3 ABCD3-Ⅰ 低危 中危 高危 低危 中危 高危 低危 中危 高危 新发脑梗死组 22(28.6) 25(39.1) 3(33.3) 9(20.0) 19(30.6) 22(51.2) 2(6.1) 24(28.9) 24(80.0) 非脑梗死组 55(71.4) 39(60.9) 6(66.7) 36(80.0) 43(69.4) 21(48.8) 31(93.9) 59(71.1) 6(20.0) χ2 1.73 9.49 31.16 P >0.05 <0.01 <0.01 表 3 2组TIA病人按照低、中、高危分层后的ABCD评分系统的比较[n;百分率(%)]
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ROC曲线分析发现,3种ABCD评分系统对7 d内继发脑梗死的预测AUC分别为0.67、0.84和0.91,均大于基准线面积的0.5,差异有统计学意义(P<0.01)。ABCD3-Ⅰ预测7 d内继发脑梗死准确度优于ABCD3,ABCD3优于ABCD2,差异具有统计学意义(P<0.01)(见表 4)。
评分系统 AUC(95% CI) P ABCD2 0.67(0.58~0.74) <0.01 ABCD3 0.84(0.71~0.90) <0.01 ABCD3-Ⅰ 0.91(0.82~0.94) <0.01 表 4 ABCD评分系统预测TIA病人发生新发脑梗死之间的比较
ABCD评分系统在短暂性脑缺血发作病人早期发生脑卒中风险的预测
Value of ABCD score in predicting early risk of cerebral ischemic stroke after transient ischemic attack
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摘要:
目的进一步明确基于中国人群的短暂性脑缺血发作(transient ischemic attack,TIA)病人,3种ABCD评分系统预测TIA发作后7 d内发生新发脑梗死风险的临床应用价值。 方法150例TIA病人于入院48 h内采用ABCD2、ABCD3、ABCD3-Ⅰ3种评分系统,根据评分分为低危、中危及高危组;根据病人TIA发作后7 d内是否继发脑梗死分为新发脑梗死组和非脑梗死组,比较2组TIA病人的3种评分系统评分;记录3种评分的低、中、高危组中TIA后7 d内继发脑梗死病人例数。 结果与非脑梗死组比较,新发脑梗死组的3种不同的ABCD系统的评分结果均升高,差异具有统计学意义(P < 0.05~P < 0.01);除ABCD2评分外,随着ABCD3、ABCD3-Ⅰ评分分值的升高,7 d内继发脑梗死率不断增加(P < 0.01);ROC曲线分析发现,3种ABCD评分系统对7 d内继发脑梗死的预测AUC分别为0.67、0.84和0.91,均大于基准线面积的0.5,差异有统计学意义(P < 0.01)。ABCD3-Ⅰ预测7 d内继发脑梗死准确度优于ABCD3,ABCD3优于ABCD2,差异具有统计学意义(P < 0.01)。 结论3种ABCD评分方法均能预测TIA后7 d内继发的新发脑梗死,分值越高,7 d内继发新发脑梗死的危险度越高,ABCD3-Ⅰ预测准确度最高。 Abstract:ObjectiveTo investigate the clinical value of three kinds of ABCD score in predicting the risk of new cerebral ischemic stroke within 7 days after transient ischemic attack(TIA)in Chinese. MethodsThe scores in 150 patients with TIA were evaluated using ABCD2, ABCD3 and ABCD3-Ⅰ score within 48 h of admission, and the patients were divided into the low, medium and high risk groups according to the score.According to the onset of new ischemic stroke within 7 days after TIA, 150 patients were divided into the new ischemic stroke group(50 patients) and non-new ischemic stroke(100 patients).Three kinds of scores between two groups were compared.The number of patients with secondary cerebral infarction in the low, medium and high risk groups within 7 days after TIA was recorded. ResultsCompared with the non-new ischemic stroke group, the scores of three kinds of ABCD score significantly increased in new ischemic stroke group, and the difference of which was statistically significant(P < 0.05 to P < 0.01).Except the score of ABCD2, with the increasing of the scores of ABCD3 and ABCD3-Ⅰ, the incidence rate of secondary cerebral infarction increased continuously within 7 days after TIA(P < 0.01).The area under the ROC curve showed that the predictive AUC value of three kinds of ABCD score was 0.67, 0.84 and 0.91 within 7 days after TIA, respectively, and the differences of those were statistically significant(P < 0.01).The degrees of accuracy of ABCD3-Ⅰ and ABCD3 score in predicting the secondary cerebral infarction within 7 days after TIA were better than those of ABCD3 and ABCD2 score, respectively(P < 0.01). ConclusionsABCD2, ABCD3 and ABCD3-Ⅰ score can predict the secondary cerebral infarction within 7 days after TIA, and the higher the score, the higher the secondary cerebral infarction risk within 7 days after TIA is.The prediction accuracy of ABCD3-Ⅰ score is the highest. -
Key words:
- transient ischemic attack /
- cerebral ischemic stroke /
- ABCD score
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表 1 2组TIA病人的一般人口学及脑血管危险因素比较(n)
分组 n 年龄/岁 男 女 BMI/
(kg/m2)高血压 糖尿病 冠心病 高脂
血症脑血
管病吸烟 饮酒 糖化血红
蛋白/%同型半胱
氨酸/(μmol/L)尿酸/
(μmol/L)低密度脂
蛋白/(mmol/L)新发脑梗死组 50 59.6±12.9 35 15 23.7±3.0 34 16 2 44 9 32 19 6.4±1.7 20.1±12.2 318.8±87.0 2.69±0.8 非脑梗死组 100 60.7±13.2 78 22 22.9±3.5 63 25 12 77 16 43 20 6.2±1.2 16.7±9.7 342.0±89.4 2.7±0.8 χ2 — -0.48* 1.15 -1.80* 0.37 0.82 1.66 2.59 0.1 5.88 5.61 0.74△ 1.85* 1.51* 0.07* P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05 >0.05 *示t值; △示t′值 表 2 2组TIA病人3种评分系统评分的比较(x±s; 分)
分组 n ABCD2 ABCD3 ABCD3-Ⅰ 新发脑梗死组 50 3.7±1.3 5.0±1.7 7.2±1.9 非脑梗死组 100 3.2±1.5 4.2±1.8 4.3±1.9 t — 2.01 2.61 8.81 P — <0.05 <0.01 <0.01 表 3 2组TIA病人按照低、中、高危分层后的ABCD评分系统的比较[n;百分率(%)]
分组 ABCD2 ABCD3 ABCD3-Ⅰ 低危 中危 高危 低危 中危 高危 低危 中危 高危 新发脑梗死组 22(28.6) 25(39.1) 3(33.3) 9(20.0) 19(30.6) 22(51.2) 2(6.1) 24(28.9) 24(80.0) 非脑梗死组 55(71.4) 39(60.9) 6(66.7) 36(80.0) 43(69.4) 21(48.8) 31(93.9) 59(71.1) 6(20.0) χ2 1.73 9.49 31.16 P >0.05 <0.01 <0.01 表 4 ABCD评分系统预测TIA病人发生新发脑梗死之间的比较
评分系统 AUC(95% CI) P ABCD2 0.67(0.58~0.74) <0.01 ABCD3 0.84(0.71~0.90) <0.01 ABCD3-Ⅰ 0.91(0.82~0.94) <0.01 -
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