摘要
目的 探讨磁共振(MRI)弥散加权成像(DWI)联合年龄、血压、临床症状、糖尿病和症状的持续时间(ABCD2)评分对老年短暂性脑缺血发作(TIA)患者继发脑梗死的预测价值.方法 回顾性选取2022年1月至2023年12月唐山市中医医院收治的108例老年TIA患者作为研究对象.按ABCD2评分将患者分为低危组(n=72)与高危组(n=36);按DWI检查结果,将患者分为DWI阳性组(n=43)与DWI阴性组(n=65).随访并记录患者90 d脑梗死发生情况,对比不同组别脑梗死发生率,比较不同DWI检查结果患者临床资料(性别、年龄、TIA发作次数≥3次、症状持续≥1 h、失语伴运动障碍、高血压、糖尿病、吸烟史、低密度脂蛋白、总胆固醇等)差异,并分析DWI、ABCD2评分及其联合对老年TIA患者发生脑梗死的预测价值.结果 随访90 d,108例患者中,有33例发生脑梗死,发生率为30.56％(33/108).较之低危组,高危组90 d脑梗死发生率显著增高(47.22％vs.22.22％),差异有统计学意义(P＜0.05).相比DWI阴性组,DWI阳性组脑梗死发生率显著增高(53.49％vs.15.38％),差异有统计学意义(P＜0.05).两组男性比例、年龄、高血压比例、糖尿病比例、吸烟史比例、低密度脂蛋白、总胆固醇等其他资料比较,差异均无统计学意义(P＞0.05);较DWI阴性组,DWI阳性组TIA发作次数≥3次比例、症状持续≥1 h比例、失语伴运动障碍比例均更高(53.49％vs.30.77％、51.16％vs.29.23％、65.12％vs.27.69％),差异均有统计学意义(P＜0.05).ABCD2 评分预测TIA患者90 d脑梗死发生的敏感度为51.52％,特异度为74.67％;DWI阳性预测的敏感度为69.70％,特异度为73.33％;二者联合预测的敏感度为90.91％,特异度为72.00％.相比各单一检查,二者联合预测敏感度显著增高(P＜0.05).结论 DWI联合ABCD2评分可较好地预测老年TIA患者90 d内脑梗死的发生.
Abstract
Objective To investigate the predictive value of magnetic resonance(MRI)diffusion weighted imaging(DWI)combined with age,blood pressure,clinical symptoms,diabetes and duration of symptoms(ABCD2)score for secondary cerebral infarction in elderly patients with transient ischemic attack(TIA).Methods A total of 108 elderly patients with TIA admitted to Tangshan Hospital of Traditional Chinese Medicine from January 2022 to December 2023 were retrospectively selected as the research objects.They were divided into the low-risk group(n=72)and the high-risk group(n=36)according to ABCD2 score.According to the results of DWI examination,the patients were divided into the DWI positive group(n=43)and the DWI negative group(n=65).The incidence of cerebral infarction in 90 days was recorded,and the incidence of cerebral infarction in different groups was compared.The clinical data(gender,age,number of TIA attacks ≥3 times,duration of symptoms≥1 h,aphasia with dyskinesia,hypertension,diabetes,smoking history,low density lipoprotein,total cholesterol,etc.)of patients with different DWI examination results were compared,and the predictive value of DWI,ABCD2 score and their combination for cerebral infarction in elderly patients with TIA was analyzed.Results After 90 days of follow-up,33 of 108 patients had cerebral infarction,with an incidence of 30.56％(33/108).Compared with the low-risk group,the incidence of 90 day cerebral infarction in the high-risk group was significantly higher(47.22％vs.22.22％),the difference was statistically significant(P＜0.05).Compared with the DWI negative group,the incidence of cerebral infarction in the DWI positive group was significantly higher(53.49％vs.15.38％),and the difference was statistically significant(P＜0.05).There were no statistically significant differences in male ratio,age,hypertension ratio,diabetes ratio,smoking history ratio,low densi-ty lipoprotein,total cholesterol and other data between the two groups(P＞0.05).Compared with the DWI negative group,the proportion of TIA episodes≥3 times,the proportion of symptoms lasting≥1 h,and the proportion of aphasia with dyskinesia in the DWI positive group were higher(53.49％vs.30.77％,51.16％vs.29.23％,65.12％vs.27.69％),and the differences were statistically significant(P＜0.05).The sensi-tivity and specificity of ABCD2 score in predicting 90 days cerebral infarction in TIA patients were 51.52％and 74.67％,respectively.The sensi-tivity and specificity of DWI positive prediction were 69.70％and 73.33％,respectively.The sensitivity of the combined prediction of the two was 90.91％,and the specificity was 72.00％.Compared with each single examination,the combined predictive sensitivity of the two was significantly higher(P＜0.05).Conclusion DWI combined with ABCD2 score can better predict the occurrence of cerebral infarction in elderly patients with TIA within 90 days.
维普
万方数据