短暂性症状伴梗死的相关危险因素分析及再发缺血性脑卒中的风险预测

The risk factors of transient symptoms associated with infarction and prediction of risk for recurrent ischemic stroke

目的探讨短暂性症状伴梗死(transient symptoms with infarction,TSI)患者的相关危险因素及进展为缺血脑卒中的风险。方法145例短暂性脑缺血发作患者在发病24 h内行头颅磁共振及DWI检查,根据DWI检查结果分为短暂性脑缺血发作(transient ischemic attack,TIA)组和TSI组,比较2组患者的一般临床资料情况。发病7 d后分别对2组患者进行随访,比较脑梗死复发的发生率。结果与TIA组相比,TSI组C反应蛋白、有TIA和卒中史、中性粒细胞数/淋巴细胞数比值(NLR)、高同型半胱氨酸血症、低密度脂蛋白(LDL-C)、ABCD2评分、运动障碍、发作次数>3次的比例显著升高,差异有统计学意义(P<0.05)。Logistic回归分析显示,既往有TIA和卒中史(OR=2.485,95%CI 1.433~4.302)、高同型半胱氨酸血症(OR=1.803,95%CI 1.171~2.775)、NLR升高(OR=3.134,95%CI 1.734~5.654)、症状发作次数>3次(OR=2.669,95%CI 1.287~5.606)及运动障碍(OR=2.055,95%CI 1.204~3.493)均与TSI患者的发生呈正相关。TSI组患者7 d后随访再发TIA及脑梗死的风险显著高于TIA组。结论既往有TIA和卒中史、NLR升高、高同型半胱氨酸血症、发作次数>3次及运动障碍是TSI的独立危险因素,对其危险因素进行早期干预,可减少TSI的发病率及卒中复发的风险。

Objective To investigate the risk factors of transient symptoms with acute infarction(TSI)and to predict the risk of ischemic stroke progression.Methods Head MRI and DWI were performed on 145 patients with transient ischemic attack within 24 hours of onset.According to the results of DWI,the patient were divided into transient ischemic attack(TIA)group and TSI group,and clinical characteristics of two groups have been compared.Two groups of patients were followed up for 7 days to compare the situation of recurrent cerebral infarction.Results Compared with TIA group,TSI group of C-reactive protein,history of TIA and stroke,neutrophil count/lymphocyte ratio(NLR),homocysteine levels,low density lipoprotein(LDL-C),ABCD2 score,movement disorders,multiple episodes,are statistically significant differences(P<0.05).Logistic regression analysis showsPrevious TIA and stroke history(OR=2.485,95%CI1.433-4.302),hyperhomocysteine(OR=1.803,95%CI1.171-2.775),elevated NLR(OR=3.134,95%CI1.734-5.654),episodes of>3(OR=2.669,95%CI1.287-5.606),and motor deficits(OR=2.055,95%CI1.204-3.493)were positively correlated with TSI.The risk of recurrent TIA and cerebral infarction in TSI group was significantly higher than that in TIA group.Conclusion Previous history of TIA and stroke,elevated NLR,hyperhomocysteine,multiple episodes,and dyspraxia are independent risk factors for TSI.Early intervention of these risk factors can reduce the incidence of TSI and the risk of stroke recurrence.