老年短暂性脑缺血发作患者早期预后不良的影响因素分析

Analysis of influencing factors of early poor prognosis in elderly patients with transient ischemic attack

目的探讨老年短暂性脑缺血发作(transient ischemic attack,TIA)早期预后不良患者的临床特征,并对预测疾病复发提供指导。方法选择2016年1月至2019年12月首都医科大学附属北京世纪坛医院神经内科诊治的315例基于"时间-症状"定义的60岁以上TIA患者,根据发病后1个月是否出现复发性脑血管事件分为复发组(n=29)和非复发组(n=286),通过Logsitic回归分析比较两组患者的临床特征。结果复发组和非复发组在高血压病史(14/15,83/203)、伴有颅内动脉狭窄(21/8,132/154)、颈动脉狭窄(22/7,107/179)、DWI阳性、伴有运动症状、TIA发作次数[2(2,3)次,2(1,2)次]、空腹血糖,糖化血红蛋白水平[8.86(8.17,9.56)mmol/L,5.82(5.27,6.33)mmol/L]方面以及颈动脉支架植入术差异有统计学意义(均P<0.05)。Logistic回归分析显示伴有DWI阳性(B=1.634,OR=5.124,95%CI:2.898~9.059,P=0.000)、颈动脉中重度狭窄(B=0.572,OR=1.773,95%CI:1.050~2.993,P=0.032)可能与早期预后不良有关。结论头颅DWI阳性和颈动脉中重度狭窄可能是老年TIA患者早期预后不良的影响因素。

Objective To analyze the clinical characteristics that affect the early outcomes of the elderly patients with transient ischemic attack(TIA)and provide the guidance for the prediction of disease recurrence.Methods From January 2016 to December 2019,315 TIA patients over 60 years old based on the time-clinical definition who were admitted to the department of neurology in Beijing Shijitan Hospital were divided into recurrence cerebrovascular events group(RCVEs group)and non-recurrence cerebrovascular events group(non-RCVEs group)according to the recurrence at 1 month after onset.The clinical characteristics of the two groups were compared by Logsitic regression analysis.Results There were 29 cases in the RCVEs group and 286 cases in the non-RCVEs group.Compared to the non-RCVEs group,patients in RCVEs group were more likely have higher prevalence of hypertension history(14/15,83/203),moderate or severe intracranial artery stenosis(21/8,132/154),carotid stenosis(22/7,107/179),DWI positive,motor symptoms,carotid artery stenting and higher times of TIA episodes(2(2,3),2(1,2)),fasting blood glucose and glycosylated hemoglobin levels(8.86(8.17,9.56)mmol/L,5.82(5.27,6.33)mmol/L).Logistic regression analysis showed that patients in RCVEs group had a DWI positive(B=1.634,OR=5.124,95%CI:2.898-9.059,P=0.000)and higher prevalence of moderate to severe stenosis of carotid artery(B=0.572,OR=1.773,95%CI:1.050-2.993,P=0.032).Conclusion DWI positive and moderate to severe carotid stenosis may influence the early poor prognosis in patients with TIA.