短暂性脑缺血发作与缺血性卒中:定义、共性和启示

Transient ischemic attack and ischemic stroke:definition,commonality and inspiration

本文对短暂性脑缺血发作与缺血性卒中的定义、共性和临床启示进行了探讨。在二者的定义部分,指出了由美国心脏协会/美国卒中协会发布的短暂性脑缺血发作和缺血性卒中定义中存在的问题,例如"短暂性"该如何界定?在二者的共性部分,在对可逆性缺血性组织(即缺血半暗带)分析的基础上,指出临床上存在症状持续24 h甚至数天而不发生梗死的情形,据此引入了持久性缺血发作(或"缺血发作持续状态")的概念。在临床启示部分,对持久性缺血发作做了进一步阐述,同时对"短暂/持久性的判定、推断及意义"进行了探讨。建议把超过某一时间阈值时缺血性卒中风险在一定时期内明显增高作为"短暂性"阈值的判定依据,该时间阈值可能在5~20 min之间,超过该阈值即可诊断为持久性缺血发作。持久性缺血发作患者有可能从静脉溶栓治疗中获益,而这也成为该时间阈值是否存在及合理的另一个判定依据。

This article discusses the definition,commonality and clinical implications of transient ischemic attack(TIA)and ischemic stroke.In the definition of the two,the problems in the definition of TIA and ischemic stroke published by the American Heart Association/American Stroke Association are pointed out,such as how to define"transient"?In the commonality part of the two,based on the analysis of reversible ischemic tissue(i.e.ischemic penumbra),It is pointed out that there is a situation that the symptoms last for 24 h or even several days without infarction in clinical practice,and the concept of persistent ischemic attack(PIA or"persistent state of ischemic attack")is introduced.In the clinical implications part,the PIA is further elaborated,and the judgment,inference and significance of transience/persistence are discussed.It is suggested that the significantly increased risk of ischemic stroke over a certain time threshold should be taken as the criterion of"transient"threshold.This time threshold may be between 5 and 20 min.If the threshold is exceeded,it can be diagnosed as PIA.Patients with PIA may benefit from intravenous thrombolytic therapy,and this also becomes another basis to determine whether the time threshold exists and is reasonable.