CTA Combined with Clinical Characteristics to Predict the Risk of Cerebral Infarction in TIA Patients with Head and Neck Atherosclerosis at Middle and High Altitude Areas
Objective Based on the head and neck CTA combined with clinical characteristics to explore the risk factors of cerebral infarction within 1 year in patients with TIA from middle and high altitude areas with head and neck atherosclerosis,and construct a risk prediction model to evaluate its predictive effectiveness.Methods A retrospective analysis was performed to continuously select TIA patients(living at an altitude of 2000-3000 m)admitted to the Fifth People's Hospital of Qinghai Province from January 2018 to September 2021.All patients were confirmed to have atherosclerotic plaques by CTA with head and neck.The patients were followed up for 1 year and divided into the non-infarction group and the infarction group according to whether there was a cerebral infarction.Firstly,the clinical data and CTA test results of the two groups of patients were analyzed by univariate analysis to screen out meaningful variables.Then,the independent influencing factors of cerebral infarction were analyzed by multivariate logistic regression,and the risk prediction model of cerebral infarction within 1 year after TIA was constructed to plot the ROC curve.Results A total of 111 patients were initially included.During follow-up,9 cases were lost to follow-up,1 case had carotid artery stenting in other hospital,and 1 case had subdural hematoma,all of which did not meet the final inclusion criteria.Finally,100 patients were included,including 26 patients in the infarction group and 74 patients in the non-infarction group.Univariate analysis showed that the ABCD2 score of the infarction group was higher than that of the non-infarction group[4.00(3.75-5.00)pointsvs.3.00(2.00-4.00)points,P=0.004].The proportion of patients with hypertension grade>1(69.23%vs.41.89%,P=0.022),unstable plaque(88.46%vs.67.57%,P=0.039),moderate to severe stenosis of vascular(53.85%vs.12.16%,P<0.001),and unstable plaque involving more than 1 vessel(69.23%vs.31.08%,P=0.001)in the infarction group were higher than those in the non-infarction group,and the differences were statistically significant.Logistic regression analysis showed that hypertension grade>1,high ABCD2 score and moderate to severe stenosis of vascular were independent risk factors for cerebral infarction within 1 year after TIA.The risk prediction model was P=1/[1+exp(-4.782+1.407×hypertension grade+0.574×ABCD2 score+2.734×vascular stenosis degree)].The AUC value of this model was 0.848(95%CI 0.763-0.933),the sensitivity was 92.31%and the specificity was 70.27%.Conclusions The risk factors for cerebral infarction within 1 year in TIA patients with head and neck atherosclerosis at middle and high altitude areas are hypertension grade>1,high ABCD2 score and moderate to severe stenosis of vascular.The prediction model constructed by the combination of these three factors together has good predictive value for cerebral infarction.
Middle and high altitudeTransient ischemic attackRisk factorCerebral infarction
万方数据
维普
