作者：蒋孝宗1 ，马兰 2 ，张守成 1 ，李澄 3

单位：

1.211300 江苏省南京市，南京鼓楼医院高淳分院神经内科；2.211300 江苏省南京市，南京鼓楼医院高淳分院检验科；3.211000江苏省南京市，东南大学附属中大医院影像科；通信作者：张守成，E-mail：tianxintianyi2014@163.com

Units：

1.Department of Neurology，Gaochun Branch of Nanjing Gulou Hospital，Nanjing 211300，China；2.Department of Clinical Laboratory，Gaochun Branch of Nanjing Gulou Hospital，Nanjing 211300，China；3.Imaging Department，Zhongda Hospital Affiliated to Southeast University，Nanjing 211000，China；Corresponding author：ZHANG Shoucheng，E-mail：tianxintianyi2014@163.com

关键词：

短暂性脑缺血发作；卒中；弥散加权成像；ABCD2 评分；预测

Keywords：

Transient ischemic attack；Stroke；Diffusion weighted imaging；ABCD2 score；Forecasting

CLC：

R 743.31　R 743

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.008

Funds：

江苏省卫生计生委 2017 年医学科研课题面上项目（H201708）

摘要：

背景　脑梗死尤其是多发脑梗死会导致短暂性脑缺血发作（TIA）患者卒中发生风险及轻度卒中患者卒中复发风险升高，因此通过影像学检查明确脑梗死类型有助于更有效地预测 TIA 患者卒中发生风险。目的　分析弥散加权成像（DWI）联合 ABCD2 评分对 TIA 患者 90 d 内卒中的预测价值。方法　选取 2011 年 10 月—2017 年 5 月南京鼓楼医院高淳分院收治的 TIA 患者 481 例，后因影像学检查结果不完整、失访排除 51 例，最终共纳入 430 例。根据 TIA 后 90 d 内卒中发生情况将所有患者分为非卒中组（n=325）和卒中组（n=105），比较两组患者一般资料、ABCD2 评分、ABCD3-I 评分、梗死类型及颈动脉狭窄率≥ 50% 情况；采用 Cox 比例风险回归模型分析 TIA 患者 90 d内卒中的影响因素；绘制 ROC 曲线以评估 ABCD2 评分、ABCD3- Ⅰ评分、DWI 联合 ABCD2 评分对 TIA 患者 90 d 内卒中的预测价值。结果　（1）两组患者男性比例，有卒中史、冠心病病史、心房颤动病史、糖尿病病史、吸烟史者所占比例及血脂异常发生率比较，差异无统计学意义（P>0.05）；两组患者年龄及有高血压病史、ABCD2 评分≥4分、ABCD3-Ⅰ评分≥7分、颈动脉狭窄率≥50%者所占比例，梗死类型比较，差异有统计学意义（P<0.05）。（2）Cox 比例风险回归模型分析结果显示，高血压病史〔HR=2.132，95%CI（1.354，3.391）〕、ABCD2 评分≥ 4 分〔HR=2.365，95%CI（1.608，3.456）〕、ABCD3- Ⅰ评分≥ 7 分〔HR=3.210，95%CI（1.125，3.774）〕、颈动脉狭窄率≥ 50%〔HR=2.369，95%CI（1.880，3.691）〕、多发脑梗死〔HR=2.441，95%CI（1.620，5.117）〕是 TIA 患者90 d 内卒中的独立危险因素（P<0.05）。（3）ROC 曲线显示，ABCD2 评分、ABCD3-I 评分、ABCD2 评分联合 DWI预测TIA患者90 d内卒中的曲线下面积（AUC）为0.651〔95%CI （0.625，0.676）〕、0.724〔95%CI （0.700，0.748）〕、0.765〔95%CI（0.741，0.787）〕；DWI 联合 ABCD2 评分预测 TIA 患者 90 d 内卒中的 AUC 大于 ABCD2 评分、ABCD3- Ⅰ评分（P<0.01）。结论　TIA 患者 90 d 内卒中发生率较高，为 24.4%（105/430），而 DWI 联合 ABCD2 评分对 TIA 患者 90 d 内卒中的预测价值较高。

Abstract：

Background　Cerebral infarction especially multiple cerebral infarction may increase the risk of strokein patients with transient ischemic attack（TIA），as well as the recurrent risk of stroke in patients with mild stroke，thus itis helpful to determine the cerebral infarction types through imaging examination to more effectively predict the risk of strokein patients with TIA. Objective　To analyze the predictive value of ABCD2 score，ABCD3- Ⅰ score and diffusion weightedimaging（DWI）combined with ABCD2 score on stroke within 90 days after TIA. Methods　A total of 481 patients with TIAwere selected in Gaochun Branch of Nanjing Gulou Hospital from October 2011 to May 2017，thereinto 51 cases were excludeddue to incomplete imaging findings or loss to follow-up，so 430 cases were enrolled finally. All of the enrolled 430 patients weredivided into non-stroke group（n=325）and stroke group（n=105）according to the incidence of stroke within 90 days afterTIA. Comparison of general information，ABCD2 score，ABCD3- Ⅰ score，infarction types and proportion of patients withcarotid stenosis rate ≥ 50% was conducted between the two groups；Cox proportional risk regression model analysis was used toanalyze the influencing factors of stroke within 90 days after TIA，moreover ROC curve was drawn to evaluate the predictive valueof DWI combined with ABCD2 score on stroke within 90 days after TIA. Results　（1）There was no statistically significantdifference in male proportion，proportion of patients with history of stroke，coronary heart disease，atrial fibrillation，diabetesor smoking，or incidence of dyslipidemia（P>0.05），while there was statistically significant difference in age，proportion ofpatients with hypertension，ABCD2 score ≥ 4，ABCD3- Ⅰ score ≥ 7 and carotid stenosis rate ≥ 50%，as well as infarctiontypes between the two groups，respectively（P<0.05）.（2）Cox proportional risk regression model analysis results showedthat，hypertension history〔HR=2.132，95%CI（1.354，3.391）〕，ABCD2 score≥4〔HR=2.365，95%CI（1.608，3.456）〕，ABCD3-Ⅰ score≥7〔HR=3.210，95%CI （1.125，3.774）〕，carotid stenosis rate≥50%〔HR=2.369，95%CI （1.880，3.691）〕and multiple cerebral infarction〔HR=2.441，95%CI（1.620，5.117）〕were independent risk factors of stroke within 90 daysafter TIA（P<0.05）.（3）ROC curve showed that，AUC of ABCD2 score，ABCD3- Ⅰ score，DWI combined with ABCD2score in predicting stroke within 90 days after TIA was 0.651〔95%CI（0.625，0.676）〕，0.724〔95%CI（0.700，0.748）〕，0.765〔95%CI（0.741，0.787）〕，respectively；AUC of DWI combined with ABCD2 score in predicting stroke within 90days after TIA was statistically significantly larger than that of ABCD2 score and ABCD3- Ⅰ score，respectively（P<0.01）.Conclusion　Risk of stroke is relatively high within 90 days after TIA，with an incidence of 24.4%（105/430），however DWIcombined with ABCD2 score has relatively high predictive on stroke within 90 days after TIA.

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