作　　者： (）;

机构地区： 广东医科大学附属第二医院

出　　处： 《广东医科大学学报》 2018年第1期15-18,共4页

摘　　要： 目的探讨神经内科临床(ABCD2)评分联合标志物检测在评估短暂性脑缺血发作(TIA)进展为脑梗死中的临床价值。方法选择在我院接受治疗并确诊为TIA患者90例为研究对象,予ABCD2评分行脑梗死风险预测,使用试剂盒检测其血清溶血磷脂酸(LPA)、血浆脂蛋白磷脂酶A2(Lp-PLA2)及高敏C反应蛋白(hs-CRP),并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析ABCD2评分联合标志物的预测价值。结果随访3个月后,30例(33.3%)TIA患者进展为脑梗死。以头颅MRI检查结果为金标准,绘制ROC曲线显示,ABCD2的AUC(authentication center)面积为0.703,灵敏度为73.3%,特异度为80.0%;LPA的AUC面积为0.642,灵敏度为63.3%,特异度为61.7%;Lp-PLA2的AUC面积为0.549,灵敏度为70.0%,特异度为73.3%;hs-CRP的AUC面积为0.522,灵敏度为66.7%,特异度为78.3%。ABCD2联合LPA、Lp-PLA2及hs-CRP的阳性预测值为90.6%,阴性预测值为98.3%,预测准确性为95.6%,漏诊率为3.3%,误诊率为5.0%,效果优于单独联合LPA或同时联合LPA+Lp-PLA2。结论 ABCD2评分联合标志物检测在预测TIA进展为脑梗死中具有良好的预警作用。 Objective To explore the clinical value of ABCD2 score combined with the detection of three biomarkers in the prediction of the progressing of transient ischemic attack（TIA） to cerebral infarction and provide more evidence reference of evidence-based medicine. Methods A total of 90 patients receiving treatment and diagnosed with TIA in our hospital form April 2016 to April 2017 were selected as research objects. ABCD2 score was used to predict the risk of cerebral infarction. ELISA kits were used to test LPA, Lp-PLA2 and hs-CR. ROC curve was used to analyze the predictive value of ABCD2 score combined with three biomarkers. Results After a follow-up of 3 months, there were 30 patients（33.3%） with the TIA progressing to cerebral infarction. The ROC curve showed that, for ABCD2, the AUC was 0.703, the sensitivity was 73.3% and the specificity was 80.0%; for LPA, the AUC was 0.642, the sensitivity was 63.3% and the specificity was 61.7%; for LpPLA2, the AUC was 0.549, the sensitivity was 70.0% and the specificity was 73.3%; for hs-CRP, the AUC was 0.522, the sensitivity was 66.7% and the specificity was 78.3%. For the ABCD2 combined with LPA, Lp-PLA2 and hs-CRP, the positive predictive value was 90.6%, the negative predictive value was 98.3%, the predictive accuracy was 95.6% and the rate of missed diagnosis was 3.3%, which was superior to the combination with LPA or the combination with LPA＋Lp-PLA2. Conclusion ABCD2 score combined with three biomarkers is effective to predict the progression from TIA to cerebral infarction, which has a good application prospect.

关 键 词： 标志物 短暂性脑缺血发作 评分 脑梗死 预测价值

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