TIA早期转化为脑梗死的血管因素分析

Analysis of Vascular Function to Early Stroke Risk after Transient Ischemic Attack

目的探讨颅内血管狭窄与短暂性脑缺血发作(transient ischemic attack,TIA)1周内转化为脑梗死的关系。方法临床收集121例TIA患者,观察患者住院1周内转化为脑梗死的百分率。查颅脑磁共振弥散加权成像(DWI)判断患者有无新鲜脑梗死,采用头颈CT血管造影(CTA)方法,检查所有患者颅内血管狭窄程度,分析颅内血管狭窄程度、部位、数量与TIA进展为脑梗死的关系。结果 121例TIA患者中,35例在发病1周内发生脑梗死(28.9%进展为脑梗死)。79例患者存在颅内血管狭窄,其中轻度狭窄36例、中度狭窄29例、重度狭窄14例。TIA后脑梗死的发生率与颅内动脉狭窄程度呈正相关(P<0.01),与颅内动脉责任血管狭窄、近端血管狭窄显著相关(P<0.01),多发脑血管狭窄导致TIA早期脑梗死的发生率明显升高(P<0.01)。结论颅内血管狭窄是TIA早期转化为脑梗死的独立危险因素,颅内血管检查有助于TIA患者早期转化为脑梗死的风险评估。

Objective To investigate the function of intracranial artery stenosis or occlusion to early stroke risk after transient ischemic attack（TIA）at 7days.Methods 121 consecutive patients with a clinical diagnosis of TIA in whom diffusion weighted imaging（DWI）and CT angiography（CTA）were performed within 24 hours of symptom onset.DWI was reviewed to diognose cerebral infarction after TIA and the stroke rate was calculated.Stenosis or occlusion of symptomatic intracranial arteries for recurrent stroke at 7 days after TIA was analysed.The characteristics of steno-occlusive lesions included the position,degree and the number.Results Of 121 TIA patients,35 cases developed into cerebral infarction,and 79 cases were found intracranial arteries stenosis or occlusion（36for mild stenosis,29 for moderate stenosis and 14 for serve stenosis）.The stroke rate was 28.9%.The cerebral infarction after TIA at 7days was significantly ralated with the stenosis of criminal arteries and proximal large intracranial arteries（P〈0.01）,as well as the moderate and serve stenosis and multiple cerebral vascular stenosis of intracranial arteries（P〈0.01）.Conclusion Cerebral vascular stenosis was the independent risk factor of early stroke after TIA at 7days.To eveluate the intracranial artery stenosis or occlusion help to predict the early risk of cerebral infarction after TIA.