柴丽丽， 赵立军， 王彦丽， 张　江

(1.秦皇岛市第四医院 综合内科， 河北 秦皇岛　066000； 2.华北理工大学附属医院 神经内科， 河北 唐山　063000)



4种ABCD评分法预测短暂性脑缺血发作后7 d内继发脑梗死风险的价值*

柴丽丽1， 赵立军1， 王彦丽1， 张江2**

(1.秦皇岛市第四医院 综合内科， 河北 秦皇岛066000； 2.华北理工大学附属医院 神经内科， 河北 唐山063000)

目的： 评价4种ABCD评分方法预测短暂性脑缺血发作(TIA)后7 d内继发脑梗死风险的价值。方法： 106例TIA患者于入院48 h内采用ABCD、ABCD2、ABCD3、ABCD3-Ⅰ 4种评分模型进行评分，根据得分将患者分为低、中及高危组；根据患者TIA后7 d内是否继发脑梗死分为脑梗死组和非脑梗死组，比较2组TIA患者的4种评分；记录4种评分的低、中、高危组中TIA后7 d内继发脑梗死患者例数，采用logistic回归方法分析4种评分与TIA患者7 d内继发脑梗死的相关性；绘制ROC曲线并用曲线下面积(AUC)评价4种评分对TIA患者近期预后预测的真实性和准确度，计算准确度最高评分的界值分值。结果： 与非脑梗死组比较，脑梗死组的4种评分方法的得分均显著升高 (P<0.01)；logistic回归分析结果显示4种评分的OR值高危组>中危组>低危组(P<0.01)；4种评分对7 d内脑梗死风险预测的AUC分别为0.61、0.65、0.77、0.89，均大于基准线面积的0.5，差异有统计学意义(P<0.05)；4种评分方法中ABCD3-Ⅰ评分预测TIA后7 d内脑梗死准确度最高(P<0.05)，最佳界值为6分。结论： 4种ABCD评分方法均能预测TIA后7 d内继发脑梗死，分值越高7 d内继发脑梗死的危险度越高；其中ABCD3-Ⅰ预测准确度最高。

脑梗塞； 脑缺血发作,短暂性； ABCD评分系统； 预测

[Abstract]Objective: To evaluate the value of ABCD score system (ABCD, ABCD2, ABCD3 and ABCD3-Ⅰ) in predicting cerebral infarction risk within 7 days after transient ischemic attack (TIA). Methods： The ABCD, ABCD2, ABCD3 and ABCD3-Ⅰ scores were adopted to evaluate the 106 TIA patients with 48 h after admission, and according to the scores the TIA patients were divided into low, medium and high risk groups. According to whether the secondary cerebral infarction occurred within 7 days after TIA the patients were divided into cerebral infarction group and non cerebral infarction group, and 4 kinds of scores were compared between the two groups. The cases of secondary cerebral infarction within 7 d after TIA were recorded among 4 kinds of scores in low, medium and high risk groups. The correlation between 4 types of scores and secondary cerebral infarction within 7 d after TIA was analyzed by logistic regression analysis. ROC curve was drawn and the area under the curve (AUC) was used to evaluate the authenticity and accuracy of the evaluation of 4 kinds of scores on the short-term prognosis of TIA patients, and the threshold value of the highest scores was calculated. Results: Compared with the non cerebral infarction group, the scores of the 4 methods of the cerebral infarction group significantly increased (P<0.01). Logistic regression analysis showed that the OR value of the 4 kinds of score followed the order: high risk group>middle risk group>low risk group (P<0.01). The AUC of 4 kinds of score in the prediction of the risk of cerebral infarction occurring within 7 days after TIA were 0.61, 0.65, 0.77, 0.89, respectively, all of which was greater than the baseline area of 0.5, and the difference was statistically significant (P<0.05). The ABCD3-Ⅰ score in the 4 scoring methods showed the highest prediction accuracy (P<0.05), and the best value was 6 points in the prediction of the cerebral infarction occurring within 7 d after TIA. Conclusions: The ABCD, ABCD2, ABCD3 and ABCD3-Ⅰ scores have the validation to predict cerebral infarction risk occurring within 7 d after TIA. The more scores, the more risks of cerebral infarction occurring within 7 d after TIA. Besides, the ABCD3-Ⅰ score showed the highest prediction accuracy.

[Key words]cerebral infarction; ischemic attack,transient; ABCD score system; predict

随着人们生活方式及饮食结构的改变，以缺血性脑卒中为主的脑血管疾病的发病率呈逐年上升趋势，大多数患者在发病前有短暂性脑缺血发作(TIA)[1]。目前，临床医生对TIA高危人群的筛查与识别主要依靠脑梗死风险评估办法。其中以ABCD评分系统应用最为广泛，ABCD评分系统有ABCD、ABCD2、ABCD3、ABCD3-Ⅰ 4种评分方法，后3种是在最初的ABCD评分方法的基础上逐渐完善而来，先后增加了糖尿病、脑功能成像(DWI)、颈动脉狭窄等评分指标，能更有效地预测TIA患者的早期卒中风险[2-3]。但上……