前循环动脉粥样硬化性短暂性脑缺血发作的血管病变及预后影响因素  

Artery abnormalities and risk factors influencing prognosis in patients with atherosclerotic transient ischemic attack of anterior circulation

作　　者：任晓梅 李玲 邱树卫[2] 徐运[2] Ren Xiaomei;Li Ling;Qiu Shuwei(Department of Neurology, Yizheng People's Hospital,Yangzhou 211400)

机构地区：[1]江苏省仪征市人民医院神经内科,211400 [2]南京大学医学院鼓楼医院

出　　处：《卒中与神经疾病》2018年第6期648-652,661,共6页Stroke and Nervous Diseases

摘　　要：目的探讨首发前循环动脉粥样硬化性短暂性脑缺血发作(TIA)的血管病变及预后影响因素。方法收集121例首发前循环动脉粥样硬化性TIA患者,发病48 h内入院,应用CT血管造影和颈动脉超声评估血管病变,采用ABCD评分,观察1年内脑血管病的发生率,比较血管病变及ABCD评分对预后的影响。结果 (1)121例患者中106例共258支血管狭窄;71例(58.68%)存在同侧颈部及颅内动脉狭窄≥50%,66例(54.55%)存在多支血管狭窄,33例(27.27%)有Willis环变异;66例(54.55%)检出不稳定斑块;(2)随访1年脑血管病发生率18.18%;多元Logistic回归分析显示除了高血压病、高脂血症、发作时间≥10 min外,同侧颈部及颅内动脉≥50%狭窄(OR=2.65,95%CI:1.30～5.38,P=0.007)是影响预后的独立危险因素;同侧颈部及颅内动脉狭窄分层后发现,同侧颈部及颅内动脉中度狭窄患者发生脑血管病的比例是正常或轻度狭窄5.92倍(95%CI:1.20～29.27,P=0.029),而重度狭窄或闭塞发生比例是正常或轻度狭窄7.92倍(95%CI:1.75～35.83,P=0.007);(3)与未发生脑血管病组比较,发生脑血管病组的ABCD2、ABCD3和ABCD3-V评分的得分均显著升高(P≤0.01);3种评分法预测1年内发生脑血管病风险的ROC曲线下面积分别为0.68、0.73和0.80,ABCD3-V评分预测预后准确度最高(P<0.05),最佳界值为7.5分。结论首发前循环动脉粥样硬化性TIA的血管病变广泛并严重,1年内脑血管病发生率高,同侧颈部及颅内动脉狭窄严重程度及ABCD3-V评分能更准确预测患者的预后。Objective To investigate artery abnormalities and risk factors influencing prognosis in patients with first atherosclerotic transient ischemic attack (TIA) of anterior circulation.Methods 121 patients with first atherosclerotic TIA of anterior circulation were admitted within 48 h of symptom onset.All patients were examined artery abnormalities with CT angiography and carotid ultrasound,and evaluated according to ABCD criteria.The occurrences of cerebrovascular diseases within 1 year after onset of TIA were observed.The risk factors influencing prognosis and the ability of ABCD score were assessed.Results All 258 arteries of106 cases presented cerebral artery stenosis including 71 cases (58.68%) of ipsilateral≥50% stenosis of carotid and intracranial artery,66 cases (54.55%) of multiple artery stenosis,33 cases (27.27%) of Willis circle variations and 66 cases (54.55%) of unstable plaques.The rate of cerebrovascular diseases within 1 year was18.18%.Multivariate logistic regression analysis showed that ipsilateral≥50% stenosis of carotid and intracranial artery (OR=2.65,95%CI=1.30~5.38,P=0.007)was significant for evaluating the prognosis after controlling for hypertension,hyperlipidemia and ischemic duration more than10 minute.If ipsilateral stenosis stratification of carotid and intracranial artery was considered,ipsilateral 50~69% stenosis of carotid and intracranial artery led to a 5.92-fold elevation (95%CI=1.20~29.27,P=0.029) of cerebrovascular diseases compared with ipsilateral<50% stenosis,meanwhile,ipsilateral≥70% stenosis led to a 7.92-fold elevation (95%CI=1.75~35.83,P=0.007).Compared with the non cerebrovascular diseases group,the scores of ABCD2、ABCD3 and ABCD3-V of cerebrovascular disease group significantly increased (P≤0.01).The AUCRoc of ABCD2,ABCD3 and ABCD3-V were 0.68,0.73 and 0.80 in predicting the risk of cerebrovascular diseases within 1 year.The ABCD3-V score showed the highest prediction accuracy (P<0.05),and the best value was7.5 points.Conclusion The artery abnormalities were ex

关 键 词：动脉粥样硬化 短暂性脑缺血发作 血管病变 ABCD评分 

分 类 号：R743.31[医药卫生—神经病学与精神病学]