CT血管造影检查联合ABCD2评分对短暂性脑缺血发作后早期脑梗死的预测价值研究

摘要

Objective To investigate the predictive value of CT angiography( CTA) combined with ABCD2 score on early cerebral infarction after transient ischemic attack ( TIA ). Methods A total of 200 TIA patients were selected in the People's Hospital of Heshan from April 2013 to May 2014,and they were divided into A group(with cerebral infarction)and B group( without cerebral infarction) according to the incidence of cerebral infarction within 7 days,each of 100 cases. CTA was used to examine carotid artery stenosis,ABCD2 score was used to evaluate illness,serum levels of MMP-9 and TIPM1 were detected by ELIXA. Results The carotid artery stenosis degree,ABCD2 score,positive rate of CTA and ABCD2 score was higher than that of control group,respectively〔(75. 85 ± 8. 96)% vs. (26. 78 ± 3. 18)%,(5. 96 ± 0. 67)vs. (2. 54 ± 0. 35),88% vs. 12%,86% vs. 14%〕(P﹤0. 05). The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of CTA and ABCD2 score combined examination on predicting early cerebral infarction after TIA was 95. 00%, 96. 00%,95. 50%,95. 96%,95. 05%, respectively, was higher than that of single CTA examination or ABCD2 score, respectively(P﹤0. 05). Xerum MMP-9 level of patients with positive result of CTA examination or ABCD2 score was higher than that of patients with negative result of CTA examination or ABCD2 score,while serum TIPM1 level of patients with positive result of CTA examination or ABCD2 score was lower than that of patients with negative result of CTA examination or ABCD2 score (P﹤0. 05). Conclusion Combined examination of CTA and ABCD2 score can accurately and sensitively predict the incidence of early cerebral infarction after TIA,reflect the degree of inflammatory reaction.%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。