预测TIA后卒中发生的343例风险分析

Analysis of the Predictive Value of the Early Risk of Stroke After Transient Ischemic Attack(TIA)

目的分析DWI以及大动脉粥样斑块形成是否有助于TIA预后的风险判断。方法收集荣成市人民医院TIA发作入院患者343例。其中339例患者行DWI检查;所有的患者均行TIA发作后颈部大动脉超声检查,并跟踪随访3个月。分别在TIA发作后的第1周以及第3个月评估检查。结果DWI的阳性率是40%(136例),患大动脉粥样斑块形成患者67例(20%),27例(8%)有房颤史。其中DWI检查阳性患者多伴随偏侧肢体障碍;TIA发病时间大于60min;大动脉粥样斑块形成。随访期间,5例(1.5%)患者在TIA后1周内有大中风发作。10例(2.9%)在3月内有一次大中风。9例TIA后卒中患者早期检查伴有DWI阳性发现。ABCD2评分及DWI的阳性发现与7d以及3个月内的卒中风险增加密切相关。在3个月时,ABCD2评分>4分,DWI的阳性表现、以及大动脉粥样硬化均为TIA发作后卒中的独立危险因素。而房颤未证实与此有关。结论DWI、颈部大动脉粥样斑块形成结合ABCD2评分可以提高TIA后卒中的风险预测。

Objective To analyze the additional predictive value of the early risk of stroke after transient ischemic attack（TIA） with diffusion-weighted imaging（DWI） and large-artery atherosclerosis（LAA）.Methods From January 2005 to September 2009,343 consecutive patients with TIA were admitted to our stroke unit.Most（339） patients underwent DWI and all had an etiologic work-up and were followed up for 3 months.Occurrence of ischemic stroke at 1 week and 3 months was assessed.Results DWI was positive in 136（40%） patients.Sixty（67%） patients had LAA and 27（8%） had AF.Patients with positive DWI findings were more likely to have unilateral weakness,TIA duration〉60 minutes,ABCD2〉4,LAA.During follow-up,5 patients had a stroke within 7 days,and 10 had a stroke within 3 months.All early strokes but 1 occurred in patients with positive DWI findings.ABCD2 score and positive DWI findings were associated with an increased 7-day and 3-month risk of stroke.At 3 months,ABCD2 score〉4;positive DWI result and LAA were independently associated with an increased risk of stroke.Which was not associated with AF.Conclusion Taking DWI and large-artery atherosclerosis into account in addition to the ABCD2 score improved the prediction of the early risk of stroke after TIA.