本文選題：腦缺血發(fā)作 + 短暫性　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景和目的 短暫性腦缺血發(fā)作是重要的腦卒中危險(xiǎn)因素，尤其是在短暫性腦缺血發(fā)作后的早期階段。2010年Merwick等提出ABCD3模型預(yù)測(cè)早期卒中發(fā)生，該模型在西方人群中具有較好的預(yù)測(cè)作用，然而在中國(guó)人群中的應(yīng)用價(jià)值尚需前瞻性研究進(jìn)行驗(yàn)證。本研究擬通過(guò)前瞻性納入連續(xù)入住鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科的短暫性腦缺血發(fā)作患者，驗(yàn)證此模型在中國(guó)人群中的應(yīng)用價(jià)值。 方法 前瞻性連續(xù)納入2010年10月至2012年9月鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科住院TIA患者。TIA采用WHO傳統(tǒng)定義，即癥狀持續(xù)時(shí)間㩳24小時(shí)，不遺留神經(jīng)功能缺損。所有患者均由統(tǒng)一培訓(xùn)的兩名或兩名以上神經(jīng)內(nèi)科醫(yī)師獨(dú)立診斷為TIA，進(jìn)行評(píng)分并完成CRF表登記，記錄所有納入患者的人口學(xué)特征及臨床資料。并完成TIA發(fā)作后第2、7、28及90天的隨訪，記錄在隨訪期內(nèi)是否發(fā)生腦卒中或TIA的復(fù)發(fā)。 使用SPSS16.0對(duì)資料進(jìn)行統(tǒng)計(jì)分析。定量資料用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,定性資料采用χ2檢驗(yàn)。采用Logistic回歸，分析影響TIA后早期卒中發(fā)生的危險(xiǎn)因素，繪制ABCD2及ABCD3的ROC曲線，計(jì)算曲線下面積，并對(duì)其曲線下面積進(jìn)行比較。先進(jìn)行單因素回歸分析(P0.1)，篩選出有統(tǒng)計(jì)學(xué)意義的變量，再用前進(jìn)法進(jìn)行多因素回歸分析（P㩳0.05）。 結(jié)果 1.共納入符合條件TIA患者320例,其中6例失訪。年齡18-86歲，平均年齡為56.97±13.399歲，其中女性129（40.3%）例，男性191（59.7%）例。90d后46例發(fā)生卒中，其中男性22例，女性24例，無(wú)死亡患者，無(wú)出血性卒中的發(fā)生。 2.隨著評(píng)分的增加，發(fā)生卒中的風(fēng)險(xiǎn)逐漸增加，2天、7天、28天及90天發(fā)生卒中的風(fēng)險(xiǎn)分別為：5.6%(3.1%-8.1%)，8.8%(5.7%-11.9%)，10.9%(7.5%-14.3%)，14.4%(10.6%-18.3%)，趨勢(shì)性檢驗(yàn)結(jié)果顯示卒中發(fā)生率與卒中是否發(fā)生有統(tǒng)計(jì)學(xué)意義，隨著評(píng)分的增加，卒中發(fā)生風(fēng)險(xiǎn)越大。 3.應(yīng)用預(yù)先設(shè)定敏感度法，得出ABCD3最佳截?cái)帱c(diǎn)為5分；2天，7天，28天，90天ABCD3模型ROC曲線下面積分別為：AUROCC=0.757（95%CI0.706-0.786），AUROCC=0.722（95%CI0.669-0.770），AUROCC=0.738（95%CI0.686-0.786），AUROCC=0.717（95%CI0.663-0.766）。2天，28天，90天ROC曲線下面積與ABCD2比較，差異均有統(tǒng)計(jì)學(xué)意義，而7天時(shí)差異無(wú)統(tǒng)計(jì)學(xué)意義。 4.Logistic回歸結(jié)果，2天時(shí)多因素回歸分析結(jié)果發(fā)現(xiàn)：ABCD3評(píng)分（OR=4.726，95%CI1.177-18.976，P=0.029）有統(tǒng)計(jì)學(xué)意義；7天時(shí)多因素分析示：ABCD3評(píng)分（OR=2.620，95%CI1.107-6.201，P=0.028）及腦梗死病史(OR=3.995，95%CI1.465-10.896，P=0.007)有統(tǒng)計(jì)學(xué)意義，與7天內(nèi)卒中發(fā)生相關(guān)（P0.05）；28天時(shí)多因素分析結(jié)果：ABCD3評(píng)分（OR=3.017，95%CI1.280-7.111，P=0.012）,腦梗死病史(OR=5.288，95%CI1.823-15.339，P=0.002)及7天內(nèi)TIA發(fā)作超過(guò)2次（OR=3.358，，95%CI1.132-9.958，P=0.029）有統(tǒng)計(jì)學(xué)意義；90天時(shí)分析結(jié)果示：ABCD3評(píng)分（OR=2.638，95%CI1.243-5.598，P=0.012）,腦梗死病史(OR=2.808，95%CI1.100-7.172，P=0.031)，7天內(nèi)TIA發(fā)作超過(guò)2次（OR=3.050，95%CI1.146-8.116，P=0.026），是各時(shí)間段進(jìn)展至腦梗死的危險(xiǎn)因素。 結(jié)論 ABCD3評(píng)分模型對(duì)住院的中國(guó)TIA人群具有良好的預(yù)測(cè)價(jià)值，較ABCD2能更好的預(yù)測(cè)早期卒中發(fā)生，為TIA后卒中預(yù)防提供良好的預(yù)測(cè)工具。
[Abstract]:Background and purpose
Transient ischemic attack is the most important risk factor for stroke, especially in transient ischemic attack in early stage after.2010 Merwick raised the ABCD3 model to predict early stroke, the model has a good prediction of the population in the west, however, the application value in the crowd China prospective studies are needed to verify the purpose of this study was to prospectively. Patients in the First Affiliated Hospital of Zhengzhou University in the continuous transient ischemic attack, to verify the application value of this model in the Chinese population.
Method
Prospective consecutive First Affiliated Hospital of Zhengzhou University from October 2010 to September 2012 in the Department of neurology patients with TIA.TIA WHO using the traditional definition, namely the duration of symptoms? 24 hours, no neurological deficit. Two or more than two neurologists and all patients were trained independently diagnosed as TIA score and complete the CRF registration form that documented clinical data and demographic characteristics of patients. And complete the TIA after the onset of 2,7,28 and 90 days of follow-up, relapse records the occurrence of cerebral stroke or TIA during the follow-up period.
Use SPSS16.0 for statistical analysis. The mean and standard deviation for quantitative data (x + s) said that the qualitative data using 2 test. Using Logistic regression analysis of risk factors for early stroke effect of TIA, ABCD2 and ROC curves of ABCD3, calculate the area under the curve, and the area under the curve were compared. The single factor regression analysis (P0.1), screened statistically significant variables, then forward multiple regression analyses (P? 0.05).
Result
1. a total of 320 eligible TIA patients were enrolled. 6 of them were lost. The average age was 56.97 + 13.399 years, including 129 (40.3%) cases, male 191 (59.7%), and.90d after 46 cases of stroke, including male 46 cases, female cases, no deaths and no hemorrhagic stroke.
2. with the score increased the risk of stroke increased gradually, 2 days, 7 days, 28 days and 90 day risk of stroke was 5.6% (3.1%-8.1%), 8.8% (5.7%-11.9%), 10.9% (7.5%-14.3%), 14.4% (10.6%-18.3%), the trend of the test results showed that the incidence of stroke and stroke occurrence statistical significance, with the score increases, the greater the risk of stroke.
3. application of preset sensitivity method, obtains the cut-off point of ABCD3 was 5; 2 days, 7 days, 28 days, 90 days ABCD3 model area under the ROC curve were: AUROCC=0.757 (95%CI0.706-0.786), AUROCC=0.722 (95%CI0.669-0.770), AUROCC=0.738 (95%CI0.686-0.786), AUROCC=0.717 (95%CI0.663-0.766).2 days, 28 days, compared the area with ABCD2 for 90 days under the ROC curve, the differences were statistically significant, but on the 7 day when the difference was not statistically significant.
The results of 4.Logistic regression, day 2 multivariate regression analysis showed that: the ABCD3 score (OR=4.726,95%CI1.177-18.976, P=0.029) were statistically significant; 7 days when multivariate analysis showed: ABCD3 score (OR=2.620,95%CI1.107-6.201, P=0.028) and cerebral infarction (OR=3.995,95% CI1.465-10.896, P=0.007) had statistical significance, associated with stroke occurred within 7 days (P0.05); multiple factor analysis for 28 days: ABCD3 score (OR=3.017,95%CI1.280-7.111, P=0.012), cerebral infarction (OR=5.288,95%CI1.823-15.339, P=0.002) and within 7 days of the onset of TIA more than 2 times (OR=3.358,95%CI1.132-9.958, P=0.029) had statistical significance; the 90 day analysis results showed: ABCD3 score (OR=2.638,95%CI1.243-5.598, P=0.012), cerebral infarction (OR=2.808,95%CI1.100-7.172, P=0.031). Within 7 days of the onset of TIA more than 2 times (OR=3.050,95% CI1.146-8.116, P=0.026), is the time to progress to the brain A risk factor for infarction.
conclusion
The ABCD3 scoring model has a good predictive value for the hospitalized Chinese TIA population. Compared with ABCD2, it can better predict the occurrence of early stroke, and provide a good prediction tool for stroke prevention after TIA.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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相關(guān)期刊論文 前2條

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