ABCD2评分法结合颅脑DWI及CTA预测TIA后脑梗死风险

目的：在ABCD2评分基础上，评估结合弥散加权成像（DWI）及CTA对短暂性脑缺血（TIA）后短期内发生脑梗死风险的预测价值。方法：连续选取本院2015年1月至2017年6月170例TIA患者（平均年龄62.4岁±5.4岁），全部患者均行DWI及CTA检查，且随访3个月。分别于7天、3个月记录患者ABCD2评分、DWI阳性结果及CTA诊断大动脉粥样硬化（LAA），以评估所有患者短期内发生脑梗死风险的预测价值。结果：170例患者中，68例（40%）患者DWI阳性，43例（25%）诊断LAA。DWI阳性患者中单侧肢体无力（OR=2.3；95% CI，1.1~4.8），TIA症状持续时间≥ 60 min（OR=3.7；95% CI，1.4~9.9），ABCD2> 5（OR=5.4；95% CI，1.5~18.8），LAA（OR=2.7；95% CI，1.3至5.5）。随访期间，7天内发生脑梗死1例，7天至3个月内发生脑梗死6例，ABCD2评分> 5（OR=24.4；95% CI，2.5~238.7），DWI阳性结果（OR=9.8；95% CI，1.1~83.1），LAA（OR=20.4；95% CI，2.4~175.1）。除1例患者外，3个月内发生脑梗死的DWI均为阳性。ABCD2评分、DWI阳性结果及LAA与7天、3个月脑梗死风险的增加是相关联的。结论：在ABCD2评分基础上引入DWI和CTA检查作为辅助，能提高对TIA后发生脑梗死风险的预测能力。

The ABCD2 Scoring Combined with DWI and CTA to Predict the Risk of Cerebral Infarction after TIA

Objective: Based on the ABCD2 score, the predictive value of DWI and CTA combined with the risk of cerebral infarction after a short-term TIA was evaluated. Methods: A total of 170 patients with TIA (average age 62.4±5.4 years) were selected consecutively from January 2015 to June 2017 in this hospital. All patients underwent DWI and CTA examinations and were followed up for 3 months. The ABCD2 score, DWI positive results, and CTA diagnosis of large artery atherosclerosis (LAA) were recorded at 7 and 3 months, respectively, to evaluate the predictive value of all patients with a short-term cerebral infarction risk. Results: Of the 170 patients, 68 (40%) were DWI positive and 43 (25%) were diagnosed with LAA. Unilateral limb weakness in DWI-positive patients (OR=2.3; 95% CI, 1.1-4.8), duration of TIA symptoms ≥ 60 minutes (OR=3.7; 95% CI, 1.4-9.9), ABCD2 >5 (OR=5.4); 95% CI, 1.5-18.8), LAA (OR=2.7; 95% CI, 1.3 to 5.5). During follow-up, 1 case of cerebral infarction occurred within 7 days, and 6 cases of cerebral infarction occurred within 7 days to 3 months. ABCD2 score was greater than 5 (OR=24.4; 95% CI, 2.5-238.7), and DWI positive result (OR=9.8; 95% CI, 1.1-83.1), LAA (OR=20.4; 95% CI, 2.4-175.1). With the exception of one patient, patients with cerebral infarction within 3 months were all positive for DWI. The ABCD2 score, DWI positive results, and LAA were associated with an increased risk of cerebral infarction at 7 days and 3 months. Conclusion: The introduction of DWI and CTA examinations based on the ABCD2 score as an aid can improve the ability to predict stroke risk after TIA.