应用ABCD模型及磁共振弥散加权成像对短暂性脑缺血发作进展为脑梗死的预测评估

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目的:
   评估ABCD2模型及磁共振弥散加权成像对短暂性脑缺血发作患者短期内进展为脑梗死的预测价值。
   方 法
   以2008年10月至2009年10月我院神经内科67例入院诊断为短暂性脑缺血发作患者进行回顾性分析。按照ABCD2模型对短暂性脑缺血发作患者进行评分和危险分层。观其实际卒中率。以ABCD2分层模型和磁共振弥散加权成像结果为协变量,实际卒中结果为应变量进行logistic分析。绘制受试者工作特征曲线,分析ABCD2分层模型与磁共振弥散加权成像的预测性能,以及两者相结合对TIA后进展为脑梗死的预测价值。
   结 果
   67例短暂性脑缺血发作患者13例卒中(19.4%)。按ABCD2评分,低危组28例中有1例发生卒中(3.6%)。中危组34例中有10例发生卒中(29.4%)。高危组5例中有2例发生卒中(40%)。67例TIA患者DWI结果为阳性者共有19例(28.3%)。进行logistic回归分析ABCD2分层模型及磁共振弥散加权成像结果均为短暂性脑缺血发作后进展脑梗死的独立因素。按ABCD2分层模型预测卒中的ROC曲线下面积为0.724[95%CI 0.587~0.862,P<0.05]。ABCD2分层+磁共振弥散加权成像检查预测卒中的ROC曲线下面积为0.815[95%CI 0.710~0.919,P<0.05]。
   结 论
   应用ABCD2评分模型对短暂性脑缺血发作患者短期内卒中风险预测可靠,并可作为短暂性脑缺血发作患者治疗干预的参考依据。应用ABCD2分层+磁共振弥散加权成像结果对短暂性脑缺血发作患者短期内卒中风险预测也有很高的预测性,其预测的价值有待扩大样本进一步探讨。
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