侧支循环对短暂性脑缺血发作后继脑梗死预后的影响

Effects of collateral pathways on prognosis of cerebral infarct patients with prior transient ischemic attack

目的研究侧支循环建立对短暂性脑缺血发作（TIA）后继脑梗死患者预后的影响并探讨其在TIA神经保护机制中的作用。方法序贯收集首次脑梗死患者164例，根据不同年龄段分为A组（年龄〈55岁）、B组（年龄55～70岁）和C组（年龄〉70岁），每组又根据病前有无同侧TIA分为A1、A2、B1、B2、C1、C2组，分别对患者人院及发病1个月时的神经功能缺损程度和日常生活活动能力、侧支循环状况、梗死体积进行评估，并分析患者侧支循环的建立状况与预后的关系。结果A1、B1组患者神经功能缺损程度评分及梗死体积明显小于A2、B2组（P〈0．01），日常生活活动能力评分、侧支循环建立发生率和良好的侧支循环建立发生率显著高于A2、132组（P〈0．01），但C1组与C2组比较差异无统计学意义（P〉0．05）。进一步研究发现侧支循环建立良好者预后较好，侧支循环建立不良者预后较差。结论TIA对后继脑梗死具有保护作用，其机制可能与侧支循环的建立有关，并与患者年龄相关。

Objective To investigate the effects of collateral pathways on prognosis of cerebral infarct patients with prior transient ischemie attack （TIA） and its role in neuroprotective mechanism of TIA. Methods A total of 164 cases of the first ever cerebral infarct patients were consecutively allocated into three groups ： A , B and C group according to their age. Three groups were divided into two subgroups respectively based on the absence or presence of prior ipsilateral TIA： A1, A2, B1, I32, C1, C2 group. Neurological dysfunctional scores at admission and 1 month after treatment, barthel index, collateral pathways status, and cerebral infarction volume were evaluated respectively. The relationship between development of collateral pathways and prognosis was assessed at the same time. Results The neurological dysfunctional scores and cerebral infarction vohme of patients in A1 group and B1 group were significantly lower than those of A2 group and I32 group （ P 〈0.01 ）. While the barthel index, the incidence of development of collateral pathways and the incidence of development of favourable collateral pathways of patients in A1 group and B1 group were significantly higher than those of A2 group and B2 group （ P 〈 0.01 ）. However, there were no significant differences between CI group and C2 group. Those patients who had favourable collateral pathways had a better prognosis, while those patients who had unfavourable collateral pathways had a worse prognosis. Conclusions Prior ipsilateral TIA has neuroprotective effect on first ever cerebral infarct patients. Its mechanisms might be related to the development of collateral pathways and the age of patients.