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目的研究CT血管造影(CTA)检查联合ABCD2评分对短暂性脑缺血发作(TIA)后早期脑梗死的预测价值。方法选择2013年4月—2014年5月鹤山市人民医院收治的TIA患者200例,根据7 d内是否发生脑梗死将患者分为脑梗死组和非脑梗死组,各100例。采用CTA检测患者颈动脉狭窄程度、ABCD2评分评估患者整体病情、酶联免疫吸附法检测患者血清基质金属蛋白酶9(MMP-9)和金属蛋白酶组织抑制剂1(TIMP1)。评价CTA检查、ABCD2评分单独检测与联合检测对脑梗死的诊断价值。结果梗死组患者颈动脉狭窄程度、ABCD2评分及CTA检查狭窄阳性率、ABCD2评分阳性率均高于非梗死组〔(75.85±8.96)%比(26.78±3.18)%,(5.96±0.67)分比(2.54±0.35),88%比12%,86%比14%〕。ABCD2评分+CTA检查判断脑梗死的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为95.00%、96.00%、95.50%、95.96%、95.05%,均高于CTA检查和ABCD2评分单独检查(P<0.05);CTA检查狭窄阳性和ABCD2评分阳性患者血清MMP-9水平分别高于阴性患者、TIMP1水平分别低于阴性患者(P<0.05)。结论 CTA检查联合ABCD2评分能够相对准确且灵敏地预测TIA后早期脑梗死的发生,同时可以反映患者炎性反应程度。
Objective To investigate the predictive value of CT angiography (CTA) combined with ABCD2 score for early cerebral infarction after transient ischemic attack (TIA). Methods From April 2013 to May 2014, 200 patients with TIA admitted to Heshan People’s Hospital were enrolled. Patients were divided into cerebral infarction group and non-cerebral infarction group (n = 100) based on whether cerebral infarction occurred within 7 days. CTA was used to detect the degree of carotid stenosis in patients. The ABCD2 score was used to evaluate the overall condition of patients. Serum MMP-9 and TIMP1 were detected by enzyme-linked immunosorbent assay. Evaluation of CTA examination, ABCD2 score alone and combined detection of cerebral infarction diagnostic value. Results The positive rate of carotid artery stenosis, ABCD2 score, CTA stenosis score and ABCD2 score in infarction group were significantly higher than those in non-infarcted group (75.85 ± 8.96% vs 26.78 ± 3.18%, 5.96 ± 0.67 (2.54 ± 0.35), 88% vs. 12%, 86% vs. 14%]. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ABCD2 score + CTA were 95.00%, 96.00%, 95.50%, 95.96% and 95.05% respectively, which were higher than those of CTA and ABCD2 alone (P <0.05). The serum levels of MMP-9 in CTA-positive stenosis and ABCD2-positive patients were higher than those in negative patients, respectively. The TIMP1 levels were lower than those in negative patients (P <0.05). Conclusion CTA combined with ABCD2 score can predict the occurrence of early cerebral infarction after TIA relatively accurately and sensitively, and can reflect the degree of inflammatory reaction in patients.