短暂性脑缺血发作的临床症状与磁共振弥散加权成像的关系  

Relation between clinical symptoms and diffusion-weighted magnetic resonance imaging in patients with transient ischemic attack

作　　者：李浩军[1] 刘振国[1] 李琳[1] 王文安[1] 周永炜[1] 陈伟[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经内科,200092

出　　处：《上海医学》2008年第12期850-852,F0002,共4页Shanghai Medical Journal

摘　　要：目的探讨短暂性脑缺血发作(TIA)患者影像学检查发现急性脑损伤的发生率,观察TIA患者症状持续时间和次数的特点,以及临床症状与磁共振弥散加权成像(DWI)检查阳性之间的相关性。方法对61例临床确诊为TIA患者的影像学检查及临床资料进行分析。结果TIA患者症状持续时间的中位数为67 min,其中83.6%者症状在1 h内缓解;发作次数的中位数为3次,其中68.9%者发作次数≤3次。影像学检查发现急性脑损伤病灶17例(27.9%)。DWI检查阳性者的中位发作次数为4次,显著高于DWI检查阴性者的1次(P<0.01),随着发作次数的上升,DWI检查阳性患者在TIA患者中所占比例也逐渐上升。DWI检查阳性与失语(OR=6.3,95%CI为1.0～38.0,P=0.031)、运动障碍(OR=24.4,95%CI为1.0～588.0,P=0.049)及发作次数>3次(OR=11.6,95%CI为1.9～69.0,P=0.007)相关。结论DWI检查评价TIA脑损伤的特异性高于常规CT和MRI检查。TIA患者中失语、运动障碍和发作次数>3次者DWI检查阳性的可能性增大。Objective To know about the incidence of the acute ischemic damage by brain imaging in patients with transient ischemia attack, and to observe the duration, frequency of the symptoms of transient ischemic attack （TIA）, so as to study the relation between the clinical symptoms and diffusion-weighted imaging （DWI） （＋）. Methods The imaging and clinical data of 61 patients, who were clinically confirmed with TIA, were retrospectively analyzed. Results The average lasting time of TIA was 67 minutes and in 83.6% patients the symptoms relieved within 1 h. The average episodes of TIA was 3 and in 68.9% patients the episodes were≤3. There were 17 patients with ischemic lesions on brain imaging （27.9%）. Patients with positive DWI scans had a significantly higher episode than those with negative DWI scans. The positive result of DWI increased with the increase of TIA episodes. Positive DWI results were correlated with aphasia （OR= 6.3, 95%CI： 1.0-38.0, P=0.031）, motor deficits （0R=24.4, 95%CI： 1.0-588.0, P=0.049）, and number of episodes〉3 （OR：11. 6, 95%CI： 1.9-69.0, P=0. 007）. Conclusion The specificity of DWI in assessing TIA-induced brain damage is better than those of CT and MRI. In patients with T1A, number of episodes）3, aphasia, and motor deficits are the independent risks of positive results of DWI.

关 键 词：短暂性脑缺血发作 影像学 弥散加权成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]