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目的研究缺血修饰白蛋白(IMA)对前循环短暂性脑缺血发作(TIA)患者继发脑梗死的预测价值。方法回顾性分析2013年1月至2015年1月期间攀枝花市中西医结合医院接收治疗的105例前循环短暂性脑缺血发作患者的临床资料,并选取同期来我院进行健康检查的80名志愿者作为对照组,分析其3、6、12 h内IMA水平,并结合ABCD2评分对前循环短暂性脑缺血发作患者后继发脑梗死的相关性进行分析。结果 105例前循环短暂性脑缺血发作患者的ROC曲线下面积(AUC)为0.838,P=0.000,95%CI为0.782~0.893。当IMA为75.28 U/L时,其特异性为76.2%,敏感度为66.7%。前循环短暂性脑缺血发作患者发病3 h内血清IMA水平高于健康对照组患者,差异具有统计学意义(P<0.05)。患者发病6 h和12 h后其IMA水平与对照组患者差异无统计学意义(P>0.05)。随访结果显示37例(35.2%)患者出现继发脑梗死,其中16例(15.2%)患者7 d内发病,21例(15.2%)患者8~30 d内发病。前循环短暂性脑缺血发作患者发作后3 h内异常升高的血清IMA、中-高危ABCD2评分为继发脑梗死的危险因素(P=0.000)。结论早期IMA水平的检测和ABCD2评分能够对前循环短暂性脑缺血发作患者继发脑梗死进行预测。
Objective To investigate the predictive value of ischemic-modified albumin (IMA) for secondary cerebral infarction in patients with TIA. Methods A retrospective analysis of clinical data of 105 patients with transient anterior circulation ischemic attack admitted to the Integrative Traditional Chinese and Western Hospital of Panzhihua from January 2013 to January 2015 was conducted and 80 health workers The volunteers served as the control group. The levels of IMA at 3, 6 and 12 h were analyzed. The correlation between IMA and ABCD2 score was analyzed in patients with recurrent transient ischemic attack after secondary cerebral infarction. Results The area under the curve of ROC (AUC) was 0.838 in 105 cases of anterior circulation transient ischemic attack, P = 0.000, 95% CI 0.782-0.893. When IMA was 75.28 U / L, the specificity was 76.2% and the sensitivity was 66.7%. The level of serum IMA in patients with anterior circulation transient ischemic attack within 3 h after onset was significantly higher than that in healthy controls (P <0.05). There was no significant difference in the IMA level between the patients and the control group 6 h and 12 h after onset (P> 0.05). Follow-up results showed that 37 (35.2%) patients had secondary cerebral infarction. Among them, 16 (15.2%) patients developed disease within 7 days and 21 (15.2%) patients developed disease within 8 to 30 days. Serum IMA, mid-high risk ABCD2 score, which were abnormally elevated within 3 h after onset of PAF, were risk factors of secondary cerebral infarction (P = 0.000). Conclusion The detection of early IMA level and ABCD2 score can predict secondary cerebral infarction in patients with TPCA.