ABCD2评分预测短暂性脑缺血发作后早期复发风险的价值

ABCD2scores predicts risk of early recurrent events after transient ischemic attack： a hospital-based case series study

关键词:  短暂性脑缺血发作  ABCD²评分  再发事件  预后

Key words:  transient ischemic attack  ABCD² score  recurrent events  prognosis

摘要:

目的探讨ABCD²评分系统对短暂性脑缺血发作（transientischemicattack，TIA）的预测价值及存在的问题。方法收集患者临床资料及磁共振弥散加权成像（difusionweightedimaging，DWI）、CT血管成像（CTangiography，CTA）的检查结果，按ABCD²评分标准完成评分。随访TIA后7dTIA、小卒中和大卒中的发生率，分析ABCD²。评分与TIA后短期再发事件的关系。ABCD²评分对于TIA后短期再发事件的预测用ROC曲线（areaunderthereceiveroperatingcharacteristiccurve）表达。结果106例TIA患者中，再发TIA24例（22．6％），再发卒中20例（18.9%）。在TIA危险因素中，再发TIA与再发卒中两组间TIA持续时间差异有统计学意义（P=0.0068）。ABCD²评分对大卒中预测价值高（AUROC=0.863，95%CI：0.799~0.926，P＜0.001），对小卒中和TIA预测价值低（AUROC=0.590，95%CI：0.499~0.681，P=0.057；AUROC=0.444，95%CI：0.373~0.515，P=0.172）。Cox风险分析发现，ABCD²。评分与TIA后7d临床复发事件间具有相关性。ABCD²评分〈3与ABCD²评分〉3两组再发事件的风险比较差异有统计学意义（HR=15.98；95%CI：6.03，42.31；P＜0.001）。结论ABCD²评分对于再发大卒中的预测价值高，可以作为急诊预测TIA患者7d再发大卒中的有效方法。

Abstract:

Objective To evaluate the ABCD² scores in predicting early recurrent events of transient ischemic attack （TIA）. Methods The clinical data of 106 patients with TIA admitted from January 2010 to December 2011 were retrospectively analyzed. And recurrent cerebrovascular events after TIA including recurrent TIA, minor stroke and major stroke were identified by face-to-face follow up. The predictive value of area under the receiver operating characteristic curve （ROC） of various parameters was evaluated. Results Of 106 patients with TIA, 24 bad a recurrent events TIA （22.6%） and 20had a recurrent stroke （18.9%） within 7 days. Duration time of TIA between recurrent TIA and recurrent stroke showed significant difference （P=0.0068）. The ABCD² scores were highly predictive for major recurrent stroke （area under ROC curve=0.863,95% CI：0.799-0.926, P＜0.001）, weakly predictive for minor recurrent stroke and recurrent TIA （area under ROC curve=0.590 and 0.444,95% CI：0.499-0.681 and 0.373-0.515, P=0.057 and 0.172, respectively）. The risk of any events within 7 d in patients with ABCD2scores ≥3 was significant different from that in patients with with ABCD² scores 〈 3 （HR=15.98, 95% CI： 6.03-42.31, P＜0.001）. Conclusion The ABCD² score system is simple and effective method to predict major recurrent stroke after TIA within 7d.