短暂性脑缺血发作患者进展为脑梗死因素的回顾性分析

Retrospective analysis of the risk factors influencing evolution from transient ischemic attack into cerebral infarction

目的探讨短暂性脑缺血发作(TIA)患者进展为脑梗死的危险因素。方法回顾性分析123例住院TIA患者的临床资料和颅内动脉磁共振血管成像(MRA)检查结果,按ABCD2评分标准给予评分,观察TIA后2周内脑梗死的发生率,分析TIA患者进展为脑梗死的危险因素。结果 TIA后32例(26.0%)患者于2周内发生脑梗死;在年龄≥60岁、单肢无力、症状持续时间≥10 min、糖尿病、ABCD2评分>3分、既往脑卒中病史、吸烟(P<0.01)、发作次数≥3次、颅内动脉狭窄≥50%(P<0.05)的患者中脑梗死的发生率显著增高,而在语言障碍不伴肢体无力、症状持续时间<10 min、高血压病、饮酒的患者中脑梗死的发生率无明显增高(P>0.05);Logistic回归分析发现,ABCD2评分>3分、糖尿病、既往脑卒中史是TIA后2周内发生脑梗死的独立危险因素。结论 TIA后进展为脑梗死与年龄≥60岁、单肢无力、症状持续时间≥10 min、糖尿病、ABCD2评分>3分、既往脑卒中病史、吸烟(P<0.01)、发作次数≥3次、颅内动脉狭窄≥50%密切相关;ABCD2评分>3分、糖尿病和既往脑卒中病史的TIA患者发生脑梗死的危险性较高;ABCD2评分法有一定的临床价值及预测性,是简单有效的预测方法,可帮助临床医生评判高危患者并进行早期干预以防止发生脑梗死;ABCD2评分法进一步结合磁共振血管成像(MRA)检查结果可提高预测的准确性。

Objective To explore the risk factors influencing transient ischemic attack （TIA） to evolve into cerebral infarction. Methods The clinical data and magnetic resonance angiography （MRA） findings were retrospectively analyzed in 123 hospitalized cases with TIA. The ABCD2 score was applied to all the patients. We observed the occurrence of cerebral infarction evolved from transient ischemie at- tack within two weeks, and analysed the risk factors influencing transient isehemie attack（TIA） to evolve into cerebral infarction. Results A total of 32 （26.0%）patients had cerebral infarction within two weeks after TIA; the rate of cerebral infarction was significantly higher in TIA patients whose age t〉60 years, who had unilateral weakness, the duration over 10 minutes, who had diabetes, the ABCD2 score 〉 3, who had previous history of stroke, history of smoking （ P 〈 0.01 ）, time of attack ≥3, and who had intraeranial arterial stenosis≥50% （ P 〈 0.05 ） ; the rate of cerebral infarction was not significantly higher in TIA patients who had speech impairment without weakness, duration 〈 10 mi- nutes, who had hypertension and drinking history（ P 〉 0.05 ）. By multiple Logistic regression analysis, ABCD2 score 〉 3, diabetes, and pre- vious history of stroke were independently associated with two - weeks risk of cerebral infarction. Conclusion Age ≥ 60 years, unilateral weakness, duration ≥10 minutes, diabetes, the ABCD2 score 〉 3, previous history of stroke, smoking, time of attack≥3, intraeranial arte- rial stenosis≥50% are significantly associated with the occurrence of cerebral infarction evolved from transient ischemic attack;there is high danger for patients to develop cerebral infarction with the ABCD2 score 〉 3, diabetes, or previous history of stroke ; ABCD2 score had clinical value in prediction, which is an easy and effective way to help clinicians select high risk patients and intervene earlier to prevent the occur- rence of cerebral infarction;the accuracy of forecasting can be improved by the combination of ABCD2 score with magnetic resonance giogra- phy（MRA） findings.