短暂性脑缺血发作短期内脑梗死发生风险的预测
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摘要
目的分析ABCD2(年龄、血压、临床症状、持续时间、糖尿病)评分、磁共振弥散加权成像(DWI)、颅内动脉磁共振血管成像(MRA)等特征预测短暂性脑缺血发作(TIA)短期内脑梗死发生风险的参考价值。方法选取2013年7月～2018年7月山东大学附属千佛山医院神经内科收治的311例TIA患者,就其ABCD2评分DWI及MRA特征进行分析,运用直线回归分析及受试者工作特征曲线(ROC),计算ABCD2评分与TIA发作后脑梗死发生的相关性,以及ABCD2评分联合DWI、MRA特征预测脑梗死发生的效能。结果 ABCD2评分危险度中危、高危者,其TIA发作后2、7和30 d脑梗死发生率均高于低危者;DWI异常者,其TIA发作后2、7和30 d脑梗死发生率均高于正常者;颅内动脉狭窄率≥50%者,其TIA发作后30 d脑梗死发生率高于<50%者,差异均有统计学意义(P <0.05)。直线回归分析结果示,ABCD2评分与TIA发作后2、7和30 d脑梗死发生率均呈线性、正相关关系,即ABCD2评分越高,脑梗死发生率越高(P <0.05)。ROC曲线示,以ABCD2评分≥4分、DWI异常、颅内动脉狭窄率≥50%联合预测TIA发作后2、7和30 d后脑梗死的曲线下面积分别为0.825、0.811和0.816,提示联合预测的准确性较高(P <0.05)。结论 TIA发作短期内脑梗死发生风险较高,联合ABCD2评分及DWI、MRA特征,能够为脑梗死的预测提供可靠参考。
Objective To study predictive value of ABCD2 score,diffusion-weighted magnetic resonance imaging(DWI) and intracranial magnetic resonance angiography(MRA) in predicting the risk of cerebral infarction in short term after transient ischemic attack(TIA). Methods 311 TIA cases admitted from july,2013 to july,2018 were selected,ABCD2 score and characteristics of DWI and MRA were analyzed. Linear regression analysis and ROC were used to calculate the correlation between ABCD2 score and the occurrence of cerebral infarction after TIA attack. ABCD2 score combined with DWI and MRA characteristics was effective in predicting the occurrence of cerebral infarction. Results The incidence of cerebral infarction on 2,7 and 30 days after TIA attack are higher in patients with moderate or high risk of ABCD2 score r than low risk of ABCD2 score. The incidence of cerebral infarction at 2,7 and 30 days after TIA attack was higher in patients with abnormal DWI than in patients with normal DWI. The incidence of cerebral infarction at 30 days after TIA attack was higher in the patients with more than 50% stenosis of intracranial artery than that in the patients with less than 50% stenosis of intracranial artery(P < 0.05). Linear regression analysis showed that there was a linear and positive correlation between ABCD2 score and the incidence of cerebral infarction after TIA attack. The higher the ABCD2 score,the higher the incidence of cerebral infarction(P < 0.05). ROC curve showed that the area under the curve was 0.825,0.811 and0.816 respectively when ABCD2 score(> 4),DWI abnormality combined with intracranial artery stenosis rate(> 50%) predicted cerebral infarction 2,7 and 30 days after TIA attack,and the accuracy of prediction was higher(P < 0.05). Conclusion TIA has a high risk of cerebral infarction in the short term. Combining ABCD2 score with DWI and MRA features can provide reliable reference for the prediction of cerebral infarction.
Objective To study predictive value of ABCD2 score,diffusion-weighted magnetic resonance imaging(DWI) and intracranial magnetic resonance angiography(MRA) in predicting the risk of cerebral infarction in short term after transient ischemic attack(TIA). Methods 311 TIA cases admitted from july,2013 to july,2018 were selected,ABCD2 score and characteristics of DWI and MRA were analyzed. Linear regression analysis and ROC were used to calculate the correlation between ABCD2 score and the occurrence of cerebral infarction after TIA attack. ABCD2 score combined with DWI and MRA characteristics was effective in predicting the occurrence of cerebral infarction. Results The incidence of cerebral infarction on 2,7 and 30 days after TIA attack are higher in patients with moderate or high risk of ABCD2 score r than low risk of ABCD2 score. The incidence of cerebral infarction at 2,7 and 30 days after TIA attack was higher in patients with abnormal DWI than in patients with normal DWI. The incidence of cerebral infarction at 30 days after TIA attack was higher in the patients with more than 50% stenosis of intracranial artery than that in the patients with less than 50% stenosis of intracranial artery(P < 0.05). Linear regression analysis showed that there was a linear and positive correlation between ABCD2 score and the incidence of cerebral infarction after TIA attack. The higher the ABCD2 score,the higher the incidence of cerebral infarction(P < 0.05). ROC curve showed that the area under the curve was 0.825,0.811 and0.816 respectively when ABCD2 score(> 4),DWI abnormality combined with intracranial artery stenosis rate(> 50%) predicted cerebral infarction 2,7 and 30 days after TIA attack,and the accuracy of prediction was higher(P < 0.05). Conclusion TIA has a high risk of cerebral infarction in the short term. Combining ABCD2 score with DWI and MRA features can provide reliable reference for the prediction of cerebral infarction.
引文
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[19]王晓明,吴卫文,陆丽霞. ABCD2评分结合颈部血管彩超对短暂性脑缺血发作后患者脑梗死预测分析[J].中国老年学杂志,2015,35(9):2395-2396.
[20]佟晓燕,白玉海,贾红娟,等. Essen卒中风险评分量表联合CTA评分对短暂性脑缺血发作患者脑梗死的预测价值[J].临床神经病学杂志,2016,29(1):27-29.
[21] Uehara T,Minematsu K,Ohara T,et al. Incidence,predictors,and etiology of subsequent ischemic stroke within one year after transient ischemic attack[J]. Int J Stroke,2017,12(1):84-89.
[22] Kamran S,Akhtar N,Alboudi A,et al. Prediction of infarction volume and infarction growth rate in acute ischemic stroke[J].Sci Rep,2017,7(1):7565.
[23]艾伟真. Essen卒中风险量表评分联合脑动脉造影对短暂性脑缺血发作患者脑梗死的预测价值分析[J].实用心脑肺血管病杂志,2016,24(11):89-92.
[24] Taguchi H,Hasegawa Y,Bandoh K,et al. Implementation of a community-based triage for patients with suspected transient ischemic attack or minor stroke study:a prospective multicenter observational study[J]. J Stroke Cerebrovasc Dis,2016,25(4):745-751.
[25] Ganzer CA,Barnes A,Uphold C,et al. Transient ischemic attack and cognitive impairment:a review[J]. J Neurosci Nurs,2016,48(6):322-327.
[2] Rothwell PM,Algra A,Chen Z,et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke:time-course analysis of randomised trials[J]. Lancet,2016,388(10042):365-375.
[3] Kernan WN,Viscoli CM,Furie KL,et al. Pioglitazone after ischemic stroke or transient ischemic attack[J]. N Engl J Med,2016,374(14):1321-1331.
[4]秦伟,杨磊,张晓丹,等. ABCD2评分和高敏C反应蛋白对短暂性脑缺血发作患者脑梗死风险的早期预测[J].中华老年心脑血管病杂志,2015,17(5):466-468.
[5]中华神经学会.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[6] Arboix A. Cardiovascular risk factors for acute stroke:risk profiles in the different subtypes of ischemic stroke[J]. World J Clin Cases,2015,3(5):418.
[7]赵立军.不同评分方法对预测短暂性脑缺血发作后近期继发脑梗死风险的临床价值[J].山西医药杂志,2017,46(5):499-502.
[8] BajkóZ,B alasa R,Mot at aianu A,et al. Malignant middle cerebral artery infarction secondary to traumatic bilateral internal carotid artery dissection. a case report[J]. J Crit Care Med,2016,2(3):135-141.
[9] Erdur H,Scheitz JF,Ebinger M,et al. In-hospital stroke recurrence and stroke after transient ischemic attack:frequency and risk factors[J]. Stroke,2015,46(4):1031-1037.
[10]倪白云,张险平,蔡红星,等.短暂性脑缺血发作后发生脑梗死的风险评估[J].中华全科医学,2015,13(8):1253-1255.
[11] Johnston SC,Amarenco P,Albers GW,et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack[J]. N Engl J Med,2016,375(1):35-43.
[12]王黎萍,朱仁洋,董芬. ABCD2评分法结合房颤改良评分法在短暂性脑缺血发作后早期脑梗死风险预测中的价值[J].浙江医学,2015,37(17):1449-1452.
[13] Amarenco P,Albers GW,Denison H,et al. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin:a subgroup analysis of SOCRATES,a randomised,double-blind,controlled trial[J].Lancet Neurol,2017,16(4):301-310.
[14] Campbell BCV,Mitchell PJ,Kleinig TJ,et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372(11):1009-1018.
[15] Sposato LA,Cipriano LE,Saposnik G,et al. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack:a systematic review and meta-analysis[J]. Lancet Neurol,2015,14(4):377-387.
[16] van Rooij FG,Kessels RPC,Richard E,et al. Cognitive impairment in transient ischemic attack patients:a systematic review[J]. Cerebrovasc Dis,2016,42(1-2):1-9.
[17] Yang J,Wong A,Wang Z,et al. Risk factors for incident dementia after stroke and transient ischemic attack[J]. Alzheimers Dement,2015,11(1):16-23.
[18] Kelly PJ,Albers GW,Chatzikonstantinou A,et al. Validation and comparison of imaging-based scores for prediction of early stroke risk after transient ischaemic attack:a pooled analysis of individual-patient data from cohort studies[J]. Lancet Neurol,2016,15(12):1238-1247.
[19]王晓明,吴卫文,陆丽霞. ABCD2评分结合颈部血管彩超对短暂性脑缺血发作后患者脑梗死预测分析[J].中国老年学杂志,2015,35(9):2395-2396.
[20]佟晓燕,白玉海,贾红娟,等. Essen卒中风险评分量表联合CTA评分对短暂性脑缺血发作患者脑梗死的预测价值[J].临床神经病学杂志,2016,29(1):27-29.
[21] Uehara T,Minematsu K,Ohara T,et al. Incidence,predictors,and etiology of subsequent ischemic stroke within one year after transient ischemic attack[J]. Int J Stroke,2017,12(1):84-89.
[22] Kamran S,Akhtar N,Alboudi A,et al. Prediction of infarction volume and infarction growth rate in acute ischemic stroke[J].Sci Rep,2017,7(1):7565.
[23]艾伟真. Essen卒中风险量表评分联合脑动脉造影对短暂性脑缺血发作患者脑梗死的预测价值分析[J].实用心脑肺血管病杂志,2016,24(11):89-92.
[24] Taguchi H,Hasegawa Y,Bandoh K,et al. Implementation of a community-based triage for patients with suspected transient ischemic attack or minor stroke study:a prospective multicenter observational study[J]. J Stroke Cerebrovasc Dis,2016,25(4):745-751.
[25] Ganzer CA,Barnes A,Uphold C,et al. Transient ischemic attack and cognitive impairment:a review[J]. J Neurosci Nurs,2016,48(6):322-327.