短暂性脑缺血发作溶栓治疗的早期疗效与ABCD^2评分的关系

Therapeutic effect of thrombolysis on patients with transient ischemic attack and relationship with ABCD^2 score

目的观察小剂量尿激酶溶栓治疗对短暂性脑缺血发作(TIA)的早期疗效和安全性,并探讨ABCD2评分与溶栓治疗效果的关系。方法 40例接受溶栓治疗的TIA患者为观察组,给予50万U尿激酶溶栓治疗,观察治疗后1周TIA发作次数、急性脑梗死和出血性疾病发生率,并与40例未溶栓治疗的TIA患者对照分析。采用ABCD2评分法将患者分为低危组、中危组和高危组,比较各亚组疗效差异。结果观察组TIA发作次数为(1.16±0.34)次,急性脑梗死发生率为2.5%,均显著低于对照组的(3.42±1.86)次和15%(P<0.05),而出血性疾病发生率比较差异无统计学意义(P>0.05)。观察组各亚组间TIA发作次数和急性脑梗死发生率比较差异均无统计学意义(P>0.05),而对照组内随危险度升高,TIA发作次数明显增加(F=10.406,P<0.05),且高危组急性脑梗死发生率显著高于低危和中危组(χ2=8.550,P<0.05)。结论 TIA患者早期溶栓治疗能减少发作次数,降低急性脑梗死风险,尤其是对于高危患者,疗效更为显著。

Objective To observe the efficacy and safety of small dose urokinase thrombolytic therapy on pa- tients with transient ischemic attack （TIA） , and to examine the relationship between ABCD2 score and the effect of thrombolytic therapy. Methods 40 TIA patients with thrombolytic therapy were enrolled as observation group, treated with 500 000 U of urokinase, TIA attack frequency, incidence of acute cerebral infarction and hemorrhagic disease were observed after treatment for 1 weeks, and compared with 40 TIA patients without thrombolytic therapy. Patients were di- vided into low risk group,medium risk group and high risk group by the ABCD2 score,and therapeutic effect of throm- bolysis was compared among subgroups. Results TIA attack frequency in observation group was （ 1. 16 ± 0. 34 ） , and incidence of acute cerebral infarction was 2.5 % , both were significantly lower than （3.42 ± 1.86） and 15 % in control group （ P 〈 0. 05 ） , and hemorrhagic disease incidence rate showed no significant difference （ P 〉 0. 05 ）. TIA attack fre- quency and incidence of acute cerebral infarction among all subgroups in observe group showed no significant differ- ence （ P 〉 0. 05 ）. While in control group, TIA attack frequency was significant different among all subgroups （ F = 10. 406, P 〈 0. 05 ） , and the incidence of acute cerebral infarction in high risk group was significantly higher than that in low risk group and medium risk group （X2 = 8. 550,P 〈 0. 05 ）. Conclusion In patients with TIA, thrombolytic therapy can reduce the attack number, reduce the risk of acute cerebral infarction, especially for high-risk patients, curative effect is more remarkable.