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目的探讨炎性因子监测联合四种评分法对短暂性脑缺血发作(TIA)后近期缺血性脑卒中风险预测价值,为其临床治疗提供参考依据。方法选择2014年1月至2016年1月秦皇岛市第四医院综合内科收治的188例TIA患者作为研究对象,纳入本研究时均采用ABCD2、埃森卒中风险评分量表(ESRS)、卒中预测工具-Ⅱ(SPI-Ⅱ)及ABCD3-Ⅰ行缺血性脑卒中风险预测,并空腹抽取静脉血检测白细胞介素(IL)-8。随访3个月记录缺血性脑卒中发生情况,并以此为终点事件,采用ROC曲线分析IL-8联合四种评分法的预测价值。结果随访3个月,188例TIA患者中有30例(16.0%)发生脑梗死。脑梗死组糖尿病、心房颤动、症状持续时间≥60 min、双重TIA、同侧颈动脉狭窄≥50.0%及DWI高信号比例高于非脑梗死组,差异均有统计学意义(P<0.05);脑梗死组ABCD2、ESRS、SPI-Ⅱ、ABCD3-Ⅰ及IL-8均明显高于非脑梗死组,差异均有统计学意义(P<0.05)。以脑梗死发生为金标准绘制ROC曲线发现,ABCD2的AUC面积为0.694,灵敏度为73.3%,特异度为88.6%;ESRS的AUC面积为0.628,灵敏度为63.3%,特异度为57.0%;SPI-Ⅱ的AUC面积为0.551,灵敏度为60.0%,特异度为53.2%;ABCD3-Ⅰ的AUC面积为0.898,灵敏度为90.0%,特异度为93.7%;IL-8的AUC面积为0.519,灵敏度为53.3%,特异度为49.4%。IL-8并联ABCD3-Ⅰ漏诊率最低,为4.7%。结论 IL-8并联ABCD3-Ⅰ预测TIA发作后近期缺血性脑卒中漏诊率较低。
Objective To explore the value of the combination of inflammatory factor monitoring and four scoring methods in predicting the risk of recent ischemic stroke after transient ischemic attack (TIA), and to provide a reference for its clinical treatment. Methods A total of 188 TIA patients admitted to the Fourth Hospital of Qinhuangdao from January 2014 to January 2016 were enrolled in this study. ABCD2, Essen’s stroke risk score (ESRS), stroke prediction tool -Ⅱ (SPI-Ⅱ) and ABCD3-Ⅰ for ischemic stroke, and venous blood was collected for the detection of interleukin-8 (IL-8). The incidence of ischemic stroke was recorded 3 months after follow-up, and as the end point, the predictive value of IL-8 combined with four scoring methods was analyzed by ROC curve. Results Three months after follow-up, 30 of 188 TIA patients (16.0%) developed cerebral infarction. Diabetes mellitus, atrial fibrillation, duration of symptom ≥ 60 min, double TIA, ipsilateral carotid artery stenosis≥50.0% and DWI high signal ratio in cerebral infarction group were higher than those in non - cerebral infarction group (P <0.05). The levels of ABCD2, ESRS, SPI-Ⅱ, ABCD3-Ⅰ and IL-8 in cerebral infarction group were significantly higher than those in non-cerebral infarction group, the difference was statistically significant (P <0.05). The AUC area of ABCD2 was 0.694, the sensitivity was 73.3% and the specificity was 88.6%. The AUC area of ESRS was 0.628, the sensitivity was 63.3% and the specificity was 57.0% The AUC area of Ⅱ was 0.551, the sensitivity was 60.0% and the specificity was 53.2%. The AUC area of ABCD3-Ⅰ was 0.898, the sensitivity was 90.0% and the specificity was 93.7%. The AUC area of IL-8 was 0.519 and the sensitivity was 53.3 %, Specificity was 49.4%. The lowest missed diagnosis rate of IL-8 ABCD3-Ⅰ was 4.7%. Conclusion IL-8 ABCD3-Ⅰ in parallel predicts a low rate of missed diagnosis of recent ischemic stroke after TIA.