發(fā)布時(shí)間：2018-06-20 02:52

  本文選題：短暫性腦缺血發(fā)作 + ABCD3�。� 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：短暫性腦缺血發(fā)作（Transient ischemic attack，TIA）是缺血性腦卒中的早期預(yù)警信號(hào)，臨床上分為前循環(huán)（頸內(nèi)動(dòng)脈系統(tǒng)）TIA及后循環(huán)（椎基底動(dòng)脈系統(tǒng)）TIA。ABCD3評(píng)分是目前對(duì)TIA進(jìn)行相關(guān)風(fēng)險(xiǎn)評(píng)估應(yīng)用較為廣泛的一種量化指標(biāo)，但ABCD3評(píng)分并不能預(yù)測(cè)出所有的腦卒中患者。血漿低密度脂蛋白膽固醇（Low Density Lipoprotein Cholesterol， LDL-C）水平是動(dòng)脈粥樣硬化（Atherosclerosis，AS）的一個(gè)主要危險(xiǎn)因素。本研究主要探討ABCD3評(píng)分聯(lián)合LDL-C水平評(píng)估TIA后卒中風(fēng)險(xiǎn)是否優(yōu)于單純應(yīng)用ABCD3評(píng)分，旨在為基層醫(yī)院找到一種經(jīng)濟(jì)實(shí)惠、便捷有效的客觀指標(biāo)，對(duì)TIA臨床治療提供依據(jù)。 目的 探討ABCD3評(píng)分聯(lián)合LDL-C水平對(duì)TIA后卒中風(fēng)險(xiǎn)的預(yù)測(cè)價(jià)值，并與ABCD3評(píng)分進(jìn)行比較，旨在為基層醫(yī)院提供一種便捷有效的評(píng)估TIA后早期卒中風(fēng)險(xiǎn)的方法，便于制定個(gè)體化的二級(jí)預(yù)防策略。 方法 以2010年9月至2013年9月在三門峽市中心醫(yī)院神經(jīng)內(nèi)科住院治療的TIA患者268例為研究對(duì)象，前瞻性收集其所有臨床資料。所有入選患者均符合WHO的TIA定義，亦經(jīng)過影像學(xué)（頭顱MRI+DWI，頸部血管B超，頭頸聯(lián)合MRA，頭頸聯(lián)合CTA，DSA等）檢查，觀察TIA后第2天，第7天是否發(fā)生卒中。所有患者均進(jìn)行ABCD3評(píng)分，并進(jìn)行風(fēng)險(xiǎn)分層，低危組（0-3分），中危組（4-6分），高危組（≥7分），并于住院第二日清晨抽取靜脈血測(cè)定其血漿LDL-C水平。用ABCD3評(píng)分法和ABCD3+LDL-C評(píng)分法分別測(cè)定268例TIA患者的評(píng)分，并觀察TIA后2天及7天內(nèi)腦梗死的發(fā)生率，并計(jì)算各自ROC曲線下面積，比較2種方法對(duì)TIA后早期腦梗死預(yù)測(cè)能力。應(yīng)用卡方檢驗(yàn)針對(duì)ABCD3L評(píng)分法各危險(xiǎn)分層間的2天、7天腦梗死發(fā)生率進(jìn)行比較，判斷各危險(xiǎn)分層間腦梗死發(fā)生的差異，指導(dǎo)臨床治療，P＜0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果 納入TIA患者268例，其中男性159例（59.3%），女性109例（40.7%），，患者年齡29-82歲，平均年齡（61.13±15.67）歲。2天內(nèi)腦梗死19例（7.1%），7天內(nèi)腦梗死28例（10.4%）。隨著評(píng)分的增加，缺血性腦卒中風(fēng)險(xiǎn)增加。2天、7天的ABCD3評(píng)分系統(tǒng)AUROC分別為0.785（95%CI=0.675-0.892，P0.001）、0.832（95%CI=0.751-0.913，P0.001）；ABCD3L評(píng)分系統(tǒng)AUROC分別為0.852（95%CI=0.762-0.943，P0.001）、0.879（95%CI=0.811-0.956，P0.001）；兩者均以ABCD3L評(píng)分系統(tǒng)曲線下面積最大（P＜0.001）。按ABCD3L評(píng)分分級(jí)，高危組（7-10分）、中危組（4-6分）、低危組（0-3分）2天內(nèi)腦梗死風(fēng)險(xiǎn)分別為20.2%、1.6%、0%（P＜0.001）；7天內(nèi)腦梗死風(fēng)險(xiǎn)分別為27.4%、3.9%、0%（P＜0.001）。ABCD3L評(píng)分為7-10分的TIA患者2天、7天梗死率分別為評(píng)分0-6分患者的12倍、7倍。 結(jié)論 將ABCD3評(píng)分與血漿LDL-C水平相結(jié)合可以更好地評(píng)估TIA患者發(fā)作后早期卒中風(fēng)險(xiǎn)。
[Abstract]:Transient ischemic attackTIA is an early warning signal for ischemic stroke. Clinical classification into anterior circulation (internal carotid artery system TIA and posterior circulation) (vertebrobasilar artery system TIA. ABCD3 score is currently used to assess the risk of TIA is a relatively wide range of quantitative indicators, but ABCD3 score can not predict all stroke patients. Plasma low density lipoprotein cholesterol low density lipoprotein Cholesteroll (LDL-C) is a major risk factor for atherosclerosis. The purpose of this study was to explore whether ABCD3 score combined with LDL-C in assessing stroke risk after TIA is superior to ABCD3 score alone in order to find an economical, convenient and effective objective index for basic hospitals and to provide evidence for clinical treatment of TIA. Objective to explore the predictive value of ABCD3 score combined with LDL-C in predicting the risk of post-TIA stroke and compare it with ABCD3 score in order to provide a convenient and effective method for assessing the risk of early post-TIA stroke in primary hospitals. Facilitate the formulation of individualized secondary prevention strategies. Methods from September 2010 to September 2013, 268 patients with TIA who were hospitalized in Department of Neurology, Sanmenxia Central Hospital, were studied and all clinical data were collected prospectively. All the patients were in accordance with WHO definition of TIA, and underwent imaging examination (head MRI DWI, cervical vascular B ultrasound, head and neck combined MRAs, head and neck combined with CTA DSA, etc.) to observe whether stroke occurred on the 2nd and 7th day after TIA. All patients were assessed with ABCD3 score and risk stratification. The low risk group was 0-3 minutes, the middle risk group was 4-6 minutes, the high risk group (鈮

本文編號(hào)：2042603