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短暂性非局灶神经症状潜在轻微缺血性卒中及其后续血管事件的高风险

Transient nonfocal symptoms are potentially a high risk for mild ischemic strokes and subsequent vascular events
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摘要 目的研究短暂性非局灶神经症状是否潜在轻微缺血性卒中(MIS)的高风险。方法选择2012年1月至2013年1月在沭阳县人民医院因短暂性非局灶神经症状就诊于神经科门诊的初诊患者(年龄≥25岁)285例为研究对象。MIS的诊断标准为美国国家卫生研究院卒中量表(NIHSS)评分〈3分。结果在285例短暂性非局灶神经症状患者中,156例(54.7%)伴MIS被MRI确诊。MIS最常见的血管受累区域是前循环(58.3%)。头晕伴头痛是更可能合并MIS风险的短暂性非局灶神经症状(32.1%vs.14.7%,P〈0.001)。多因素分析表明,中年(RR 1.082,95%CI 1.157~1.189)和较高的ABCD2评分(RR 7.915,95%CI 4.648~13.480)与短暂性非局灶神经症状伴MIS显著相关。尽管MIS有良好的生存率,但MIS组患者未经调整的后续血管事件(SVE)的发生率比没有MIS的患者显著增高(32.7%vs.19.4%,P=0.011),未调整的SVE风险比高达6.38(95%CI 2.271~13.260)。结论半数以上的短暂性非局灶神经症状潜在MIS的高风险,其特点是好发于中年,有高ABCD2评分和高风险的SVE。前循环是短暂性非局灶神经症状伴MIS的重要区域之一。 Objective To investigate whether the transient nonfocal symptoms are potentially a big risk for minor ischemic strokes( MIS). Methods A retrospective cohort study was conducted in a neurology outpatient( with age≥25 years old) in Affiliated Shuyang People' s Hospital of Xuzhou Medical University between January 2012 and January 2013. The diagnostic criteria of MIS was used the National Institutes of health stroke scale( NIHSS) 3 score,and had undergone a magnetic resonance imaging( MRI) study of the brain in the first visit of 24 hours. Results Of 285 outpatient patients identified,156( 54. 7%) transient nonfocal symptoms due to MIS were diagnosed by MRI. The most common affected vascular territory for MIS was in the anterior circulation artery( ACA) regions(58. 3%). Dizziness with headache were more likely to be associated with the most common transient nonfocal symptoms for MIS' risk(32. 1% vs. 14. 7%,P〈0. 001).In a multivariate analysis,middle aged( RR 1. 082,95% CI 1. 157-1. 189) and higher initial ABCD score( RR7. 915,95% CI 4. 648-13. 480) was significantly associated with transient nonfocal symptoms with MIS. For these with MIS,survival rate was favorable,but unadjusted incidence of subsequent vascular events( SVE) was significantly higher(32. 7% vs. 19. 4%,P = 0. 011),and the unadjusted risk ratio for SVE was 6. 38( 95%CI 2. 271-13. 260). Conclusion Over half of transient nonfocal symptom is caused by MIS,which is characterized by middle aged,higher ABCD2 score,and high-risk SVE. The ACA region is one of the important pathways for transient nonfocal symptoms.
出处 《中华脑科疾病与康复杂志(电子版)》 2016年第3期136-141,共6页 Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)
基金 江苏省临床重点专科建设项目(20160013)
关键词 卒中 磁共振成像 后续性血管事件 暂时性非局灶神经症状 Stroke Magnetic resonance imaging Subsequent vascular events Transient nonfocal symptoms
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