头颈CTA联合ABCD2评分量表对椎基底动脉短暂性脑缺血发作患者脑梗死的预测价值

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摘要目的探讨头颈CT血管成像（CTA）联合ABCD2评分量表对椎基底动脉短暂性脑缺血发作（TIA）患者脑梗死的预测价值。方法收集内蒙古医科大学附属医院2014年2月～2016年2月收治的92例TIA患者的一般资料，采用ABCD2评分法、CTA评价方法及CTA联合ABCD2评分法，根据患者的临床表现和头颈MRI弥散加权检查判断TIA是否发展为脑梗死，记录TIA后7 d内出现脑梗死的比例。结果 ABCD2评分法中，高危组脑梗死的发病率最高，其次为中危组及低危组，差异有高度统计学意义（Z = 8.394，P ＜ 0.01）；头颈CTA提示：存在脑血管狭窄者脑梗死发生率与其狭窄程度有关，依次为重度＞中度＞正常/低度，差异有统计学意义（Z = 10.231，P ＜ 0.05）；CTA联合ABCD2评分中，低危脑梗死发生率为9.5%，明显低于高危脑梗死发生率（27.6%），差异有统计学意义（χ2=19.256，P ＜ 0.05）；ABCD2评分预测1年后脑梗死风险的ROC曲线下面积为0.683（95%CI：0.606～0.794，P ＜ 0.05），CTA联合ABCD2评分为0.801（95%CI：0.740～0.842，P ＜ 0.05）。结论 ABCD2评分能够有效地预测患者出现TIA后是否进展为脑梗死，如再结合头颈部CTA检查，能够进一步提高预测准确性，对于椎基底动脉TIA患者脑梗死的预测切实可行。

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	吕铁钢1 刘佳2 郝健3▲

关键词 ： ABCD2评分, 头颈CT血管成像, 椎基底动脉, 短暂性脑缺血发作, 脑梗死, 预测价值

Abstract：Objective To investigate the predictive value of head and neck CT angiography (CTA) combined with ABCD2 scale for the cerebral infarction in patients with transient ischemic attack (TIA) of vertebral basilar artery. Methods The clinical data of 92 patients with TIA admitted to the Affiliated Hospital of Inner Mongolia Medical University from February 2014 to February 2016 were collected. By using ABCD2 score method, CTA evaluation method and CTA combined with ABCD2 score method, according to patients' clinical symptoms and head and neck MRI diffusion-weighted, TIA was judged whether it was developed for cerebral infarction, and the proportion of cerebral infarction within 7 d after TIA was recorded. Results ABCD2 score method showed that, the incidence of cerebral infarction in high-risk group was the highest, followed by moderate and low risk group, the difference was highly statistically significant (Z = 8.394, P ＜ 0.01); head and neck CTA showed that the incidence of cerebral infarction in patients with cerebrovascular stenosis was related to its degree of stenosis, followed by severe＞moderate＞normal/low, with significant difference (Z = 10.231, P ＜ 0.05); according to CTA joint ABCD2 score, the incidence of cerebral infarction for low risk was 9.5%, which was significantly lower than that of high risk (27.6%), the difference was statistically significant (χ2=19.256, P ＜ 0.05); the area under curve of ROC of the risk of cerebral infarction after 1 year predicted by ABCD2 score was 0.683 (95%CI: 0.606-0.794, P ＜ 0.05), which of CTA combined with ABCD2 score was 0.801 (95%CI: 0.740-0.842, P ＜ 0.05). Conclusion ABCD2 score can effectively predict the early development of cerebral infarction after TIA, and it is possible to further improve the prediction accuracy by checking with head and neck CTA inspection, which is also feasible for predicting the cerebral infarction of patients with TIA of vertebral basilar artery.

Key words： ABCD2 score Head and neck CT angiography Vertebral basilar artery Transient ischemic attack Cerebral infarction Predictive value

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引用本文:

吕铁钢1 刘佳2 郝健3▲. 头颈CTA联合ABCD2评分量表对椎基底动脉短暂性脑缺血发作患者脑梗死的预测价值[J]. 中国医药导报, 2017, 14(35): 62-65,70.
LYU Tiegang1 LIU Jia2 HAO Jian3▲. Predictive value on head and neck CTA combined with ABCD2 scale for the cerebral infarction in patients with transient ischemic attack of vertebral basilar artery . 中国医药导报, 2017, 14(35): 62-65,70.

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[1] Lee J，Inoue M，Mlynash M，et al. MR perfusion lesions after TIA or minor stroke are associated with new infarction at 7 days [J]. Neurology，2017，88（24）：2254-2259.
[2] Sahara N，Kuwashiro T，Okada Y. Cerebral infarction and transient ischemic attack [J]. Nihon Rinsho，2016，74（4）：666-670.
[3] Fu J，Tang J，Yang J，et al. Adding computed tomography and transcranial Doppler findings to the ABCD2 score topredict long-term risk of stroke after transient ischaemic or minor stroke [J]. Eur J Neurol，2015，22（3）：520-526.
[4] Hotter B，Ostwaldt AC，Levichev-Connolly A，et al. Natural course of total mismatch and predictors for tissue infarction [J]. Neurology，2015，85（9）：770-775.
[5] 黄德源.脑血管的基础与临床[M].哈尔滨：黑龙江人民出版社，1995.
[6] Ryan DJ，Kenny RA，Christensen S，et al. Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis [J]. Age Ageing，2015，44（4）：655-661.
[7] 杨洁，区腾飞，蒲蜀湘，等.卒中及短暂性脑缺血发作患者不同部位脑萎缩的危险因素[J].中国神经精神疾病杂志，2016，42（10）：609-615.
[8] Huang HL，Wang N，Zhou H，et al. Study on influence of transient ischemic on subsequent cerebral infarction [J]. Eur Rev Med Pharmacol Sci，2016，20（24）：5164-5167.
[9] Xu Y，Lv JH，Ma L，et al. Multi-parameter arterial spin labeling versus dynamicmagnetic-sensitive enhanced cerebral perfusion imaging for diagnosis of transient cerebral ischemic [J]. Nan Fang Yi Ke Da Xue Xue Bao，2016，36（6）：768-774.
[10] Zhang Y，Fan D，Zhang N. The relationship between serum asymmetricdimethylarginine and ABCD2 score in transient ischemic patients [J]. Zhonghua Nei Ke Za Zhi，2014， 53（11）：876-879.
[11] Cutting S，Regan E，Lee VH，et al. High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic [J]. Cerebrovasc Dis Extra，2016，6（3）：76-83.
[12] 顾言，陈建荣，成静.ABCD2评分联合颈动脉超声对TIA进展为脑梗死的预测评估[J].实用医学杂志，2016，32（18）：2952-2955.
[13] Hankey GJ. The ability of the ABCD2 score to predict stroke 1 year after TIA or minor stroke was assessed [J]. Ann Intern Med，2016，165（4）：JC23.
[14] Knoflach M，Lang W，Seyfang L，et al. Predictive value of ABCD2 and ABCD3-I scores in TIA and minor stroke in the stroke unit setting [J]. Neurology，2016，87（9）：861-869.
[15] 王彦华，路永坤，刘向哲，等.ABCD2评分结合DWI和PWI对TIA后发生脑梗死的预测价值[J].中风与神经疾病杂志，2016，33（12）：1098-1100.
[16] Lima Filho JB，de Lima Teixeira I，Luvizutto GJ，et al. ABCD2 score and secondary stroke prevention：Meta-analysis and effect per 1，000 patients triaged [J]. Neurology，2016，86（7）：697.
[17] Diener HC，Frank B. Stroke：Stroke prevention--time to say goodbye to the ABCD2 score? [J]. Nat Rev Neurol，2015， 11（10）：552-553.
[18] 张艳明，宋则周，傅燕飞，等.超声造影评估颈动脉斑块新生血管联合ABCD评分预测短暂性脑缺血发作进展为脑梗死的价值[J].中华超声影像学杂志，2016，25（8）：687-690.
[19] Wardlaw JM，Brazzelli M，Chappell FM，et al. ABCD2 score and secondary stroke prevention：meta-analysis and effect per 1，000 patients triaged [J]. Neurology，2015，85（4）：373-380.
[20] Dutta D，Bailey SJ. Validation of ABCD2 scores ascertained by referringclinicians：a retrospective transient ischaemic clinic cohort study [J]. Emerg Med J，2016，33（8）：543-547.
[21] Hachisuka A，Matsushima Y，Hachisuka K，et al. A Case of Apoplexy Attack-Like Neuropathy due to Hereditary Neuropathy with Liability to Pressure Palsies in a Patient Diagnosed with Chronic Cerebral Infarction [J]. J Stroke Cerebrovasc Dis，2016，25（6）：83-85.
[22] Chu T，Yu W，Wang Y，et al. The ABCD2 score mayunderestimate the short-term risk of stroke in Chinese population： a meta-analysis [J]. Neuro Endocrinol Lett，2015， 36（3）：262-268.