CAJ | 학술논문

目的：验证由ABCD2评分系统改进而来的ABCD3-I评分系统对短暂性脑缺血发作（ TIA）后7 d及90 d内发生卒中的预测价值。方法回顾性收集2008年1月-2012年6月在浙江医院神经内科住院的符合入选标准的TIA患者131例，对其临床、影像学表现及预后等进行分析，通过ROC曲线下面积（ AUC）评估ABCD3-I评分对TIA后发生卒中的预测价值，并应用Logistic回归分析相关危险因素。结果131例TIA患者中9例（6.9％）于7d内发生卒中，17例（13.0％）于90 d内发生卒中。ABCD2评分系统预测7 d内发生卒中的AUC为0.719〔95％CI（0.573，0.864），P＝0.029〕；ABCD2评分系统预测90 d内发生卒中的AUC为0.635〔95％CI（0.512，0.758），P＝0.073〕。ABCD3-I评分系统预测7 d内发生卒中的AUC为0.768〔95％CI（0.609，0.927），P＝0.007〕，与ABCD2评分系统比较差异无统计学意义（ Z ＝0.447，P ＝0.655）。ABCD3-I评分系统预测90 d 内发生卒中的 AUC 为0.807〔95％CI （0.702，0.911），P＝0.000〕，与ABCD2评分系统比较差异有统计学意义（ Z＝2.089，P＝0.037）。磁共振弥散加权成像（MR-DWI）高信号〔OR＝4.086，95％CI（1.271，13.136），P ＝0.018〕及颈内动脉狭窄〔OR＝3.825，95％CI（1.024，14.293），P＝0.046〕是TIA后90d内发生卒中的危险因素。结论 ABCD3-I评分系统是一个能预测TIA后7 d和90 d内发生卒中风险的良好工具。与ABCD2评分系统相比该评分能更好地预测TIA后远期发生卒中的风险，对TIA患者进行MR-DWI及血管影像学的检查有助于评估远期内发生卒中的风险。
목적：험증유ABCD2평분계통개진이래적ABCD3-I평분계통대단잠성뇌결혈발작（ TIA）후7 d급90 d내발생졸중적예측개치。방법회고성수집2008년1월-2012년6월재절강의원신경내과주원적부합입선표준적TIA환자131례，대기림상、영상학표현급예후등진행분석，통과ROC곡선하면적（ AUC）평고ABCD3-I평분대TIA후발생졸중적예측개치，병응용Logistic회귀분석상관위험인소。결과131례TIA환자중9례（6.9％）우7d내발생졸중，17례（13.0％）우90 d내발생졸중。ABCD2평분계통예측7 d내발생졸중적AUC위0.719〔95％CI（0.573，0.864），P＝0.029〕；ABCD2평분계통예측90 d내발생졸중적AUC위0.635〔95％CI（0.512，0.758），P＝0.073〕。ABCD3-I평분계통예측7 d내발생졸중적AUC위0.768〔95％CI（0.609，0.927），P＝0.007〕，여ABCD2평분계통비교차이무통계학의의（ Z ＝0.447，P ＝0.655）。ABCD3-I평분계통예측90 d 내발생졸중적 AUC 위0.807〔95％CI （0.702，0.911），P＝0.000〕，여ABCD2평분계통비교차이유통계학의의（ Z＝2.089，P＝0.037）。자공진미산가권성상（MR-DWI）고신호〔OR＝4.086，95％CI（1.271，13.136），P ＝0.018〕급경내동맥협착〔OR＝3.825，95％CI（1.024，14.293），P＝0.046〕시TIA후90d내발생졸중적위험인소。결론 ABCD3-I평분계통시일개능예측TIA후7 d화90 d내발생졸중풍험적량호공구。여ABCD2평분계통상비해평분능경호지예측TIA후원기발생졸중적풍험，대TIA환자진행MR-DWI급혈관영상학적검사유조우평고원기내발생졸중적풍험。
Objective To validate the prognostic value of ABCD3 - I score improved from the ABCD2 score in 7 - day and 90 - day stroke risk after TIA. Methods 131 patients presented with TIA hospitalized in neurology department of Zhejiang Hospital from January 2008 to June 2012 were retrospectively studied,and the clinical manifestations,imaging findings and possible outcome and so on were analyzed. The predictive ability of ABCD3 - I score was assessed by calculating the area under the ROC curve. Logistic regression analysis was used to analyze some related risk factors. Results 9(6. 9%)out of 131 patients suffered from stroke in 7 day after TIA,and 17(13. 0%)in 90 days. The area under the ROC curve(AUC)in 7 - day stroke of ABCD2 score system was 0. 719〔95%CI(0. 573,0. 864),P =0. 029〕,and the AUC in 90 - day stroke was 0. 635〔95% CI(0. 512,0. 758),P =0. 073〕. Meanwhile,the AUC in 7 - day stroke of ABCD3 - I system was 0. 768〔95%CI(0. 609, 0. 927),P =0. 007〕,which had no significant difference with ABCD2 score(Z =0. 447,P =0. 655). The AUC in 90 - day was 0. 807〔95%CI(0. 702,0. 911),P = 0. 000〕and it had a higher sensitivity in prediction of 90 - day stroke compared with ABCD2 score system(Z =2. 089,P =0. 037). High signal of MR - DWI〔OR =4. 086,95%CI(1. 271,13. 136),P =0. 018〕and carotid artery stenosis≥50% 〔OR =3. 825,95% CI(1. 024,14. 293),P = 0. 046〕were the risk factors for 90 - day stroke after TIA. Conclusion ABCD3 - I score was a better tool to predict the stroke risk in 7 - day and 90 - day after TIA. It can predict the long - term stroke risk much better than ABCD2 score. Carrying out MR - DWI and some imaging examinations on TIA patients can help assess the long - term risk of stoke.