摘要
目的应用数字减影血管造影(DSA)技术,对短暂性脑缺血发作(TIA)有卒中高危因素患者的颅内外大动脉狭窄进行研究。方法采用ABCD评分工具,对48h内入院的非心源性TIA患者进行危险分层,于入院5d内完成DSA检查,根据颅内外动脉狭窄程度的分值,创建新的ABCD+DSA(ABCDA)评分工具。比较这两种评分工具对卒中风险的预测及其分层有无统计学差异。结果在纳入的88例患者中,有37.5%(33例)的患者在90d内发生卒中,其中伴有≥70%狭窄和闭塞的占66.7%(22例),在无动脉狭窄8例中,仅1例发生卒中。两种评分工具对30d和90d的卒中风险预测均有较高的价值,而ABCDA评分的预测能力则更强。按照ABCD评分分层,本组评分为≥5分组与评分<5分组之间,短期内累计的卒中发生率无统计学差异。在添加DSA项目的分值后,评分为≥5分的患者在30d内发生卒中的风险增加了6倍,在90d内增加了4倍。结论颅内外动脉≥70%狭窄或闭塞是TIA短期内发生卒中的高危人群。ABCDA评分不仅能增强风险的预测和分层能力,并且在卒中的二级预防上有着重要的指导意义。
Objective To detect extra-and intracranial arterial stenosis of patients with transient ischemic attack（TIA）and high-risk factors for stroke with the help of digital substract angiography（DSA）technique.Method All TIA patients were admitted within 48 hours from the last onset of symptoms and stratified according to the 6-point ABCD score.DSA was performed within 5 days after hospitalization.The 7-point ABCDA score was established by adding to the ABCD score an additional item（A=angiography）from the DSA.Differences between groups predicted and stratified by the ABCD score and the ABCDA score were assessed for statistical significance.Results Of 88 patients,the 90-day stroke was 37.5%（33 cases）,severe artery stenosis（≥70%）or occlusion rate was 66.7%（22 cases）.There was only one stroke in 8 patients with no arterial lesion.The ABCD and ABCDA scores could predict stroke risk at both 30 days and 90 days.Compared to the ABCD score the ABCDA score was slightly better to predict the stroke risk of patients with a TIA.According to risk stratification of ABCD score,no significatant differences in stroke-free survival were assessed between groups with a scores of 5 or greater and a scores of 4 or less.The ABCDA scores of 5 or greater were associated with a 6-fold increase in stroke risk at 30 days and with a 4-fold increase at 90 days.Conclusion TIA patients with severe extra-and intracranial arterial stenosis or occlusion have a high stroke risk.The new ABCDA score has a better prediction ability of stroke risk after TIA and play important role on the secondary prevention of stroke.
出处
《中风与神经疾病杂志》
CAS
CSCD
北大核心
2010年第4期321-325,共5页
Journal of Apoplexy and Nervous Diseases
