CAJ | 학술논문

目的探讨ABCD2评分法结合三种影像学方法对短暂性脑缺血发作(TIA)患者脑梗死的发生进行风险评估.方法选择2007年1月至2011年12月就诊于我院的578例TIA患者,采用ABCD2评分法、磁共振弥散加权成像( DWI)、磁共振血管造影(MRA)及颈动脉彩色多普勒超声(CDFI)对TIA后发生脑梗死的危险度进行分组评估,随访2、7、30 d内脑梗死发生率.结果 578例TIA患者2、7、30 d内发生脑梗死者分别为37例(6.40％)、47例(8.13％)、61例(10.55％)；单用ABCD2评分法对TIA后发生脑梗死危险分层研究发现,高危组(35例)2、7、30 d内发生脑梗死者分别为15例(42.86％)、18例(51.43％)、21例(60.00％)；ABCD2＞3分且DWI阳性者(51例)TIA后2、7、30 d发生脑梗死者达28例(54.90％)、31例(60.78％)、38例(74.51％)；ABCD2 ＞3分且MRA脑动脉狭窄者(36例)TIA后2、7、30 d发生脑梗死者达22例(61.11％)、24例(66.67％)、30例(83.33％),ABCD2＞3分且CDFI颈动脉粥样斑块致管腔狭窄者(35例)其结果为21例(60.00％)、23例(65.71％)、28例( 80.00％)；三种方式对高危TIA患者短期发生脑梗死的评估价值比较差异无统计学意义(P均＞0.05).结论 TIA患者在短期内可进展为脑梗死；ABCD2评分法对TIA后2～30 d内脑梗死发生有一定的预测价值,但仅为临床简单评估方法；对ABCD2评分＞3分的中、高危患者可结合DWI、MRA等检查进一步提高预测的准确性,帮助临床医师更好地识别脑梗死发生的高危患者.
목적 탐토ABCD2평분법결합삼충영상학방법대단잠성뇌결혈발작(TIA)환자뇌경사적발생진행풍험평고.방법 선택2007년1월지2011년12월취진우아원적578례TIA환자,채용ABCD2평분법、자공진미산가권성상( DWI)、자공진혈관조영(MRA)급경동맥채색다보륵초성(CDFI)대TIA후발생뇌경사적위험도진행분조평고,수방2、7、30 d내뇌경사발생솔.결과 578례TIA환자2、7、30 d내발생뇌경사자분별위37례(6.40％)、47례(8.13％)、61례(10.55％)；단용ABCD2평분법대TIA후발생뇌경사위험분층연구발현,고위조(35례)2、7、30 d내발생뇌경사자분별위15례(42.86％)、18례(51.43％)、21례(60.00％)；ABCD2＞3분차DWI양성자(51례)TIA후2、7、30 d발생뇌경사자체28례(54.90％)、31례(60.78％)、38례(74.51％)；ABCD2 ＞3분차MRA뇌동맥협착자(36례)TIA후2、7、30 d발생뇌경사자체22례(61.11％)、24례(66.67％)、30례(83.33％),ABCD2＞3분차CDFI경동맥죽양반괴치관강협착자(35례)기결과위21례(60.00％)、23례(65.71％)、28례( 80.00％)；삼충방식대고위TIA환자단기발생뇌경사적평고개치비교차이무통계학의의(P균＞0.05).결론 TIA환자재단기내가진전위뇌경사；ABCD2평분법대TIA후2～30 d내뇌경사발생유일정적예측개치,단부위림상간단평고방법；대ABCD2평분＞3분적중、고위환자가결합DWI、MRA등검사진일보제고예측적준학성,방조림상의사경호지식별뇌경사발생적고위환자.
Objective To investigate the risk of cerebral infarction on pat ients with transient ischemicattack (TIA) by combining ABCD2 score and three imaging methods.Methods Five hundred and seventy-eight patients with TIA visiting our hospital from January 2007 to December 2011 were assessed for the risk of cerebral infarction after TIA by ABCD2 score method,magnetic resonance diffusion weighted imaging (DWI),magnetic resonance angiography (MRA) and carotid artery color Doppler imaging (CDFI).Cases were followed up on 2 d,7 d and 30 d for incidence of cerebral infarction.Results Cerebral infarction occurred in 37 cases (6.40％),47 cases ( 8.13％ ) and 61 cases ( 10.55％ ) on day 2,day 7 and day 30.The occurrence of cerebral infarction after TIA in high risk group (35 cases ) by single ABCD2 score was found in 15 cases (42.86％ ),18 cases (51.43％) and 21 cases (60.00％) on day 2,day 7 and day 30.Twenty-eight cases (54.90％),31cases (60.78％ ),and 38 cases (74.51％ ) of patients after TIA with ABCD2 ＞ 3 and DWI positivity (51cases) suffered cerebral infarction on day 2,day 7 and day 30.Cerebral infarction occurred in 22 cases (61.11％),24 cases (66.67％ ) and 30 cases (83.33％) of patients with ABCD2 ＞ 3 points and cerebral artery stenosis (36 cases) on day 2,day 7 and day 30 after TIA.The occurrence of cerebral infarction after TIA on day 2,day 7 and day 30 were in 21 cases ( 60.00％ ),23 cases ( 65.71％ ),28 cases ( 80.00％ ) of the patients with ABCD2 ＞ 3 points and the carotid artery atheroma-caused bureaucratic stenosis (35 cases).There were no significant difference in the value of three methods to assess the risk of cerebral infarction in high-risk TIA groups (P ＞ 0.05).Conclusion TIA patients can progress to cerebral infarction in the short term.There are some predictive value by ABCD2 score from 2 to 30 days for cerebral infarction occurring after TIA,but it is only a simple clinical assessment method.ABCD2 score ＞ 3 points must be combined with DWI,MRA,and other tests in high-risk patients to identify the risk of cerebral infarction,thus improving the accuracy of the prediction.The combined evaluation of TIA patients will help the clinicians give better treatment and decision to this group of patients