鉴别短暂视觉障碍亚型用于急诊TIA的病因分析和预后判断  

Subtype identification of transient visual disorders contributes to confirmation of pathogenesis and assessment of prognosis in patients with transient ischemic attack

作　　者：朱鑫璞[1] 沈凌达[1] 郑天衡[1] 肖晶晶[1] 王少石[1] 

机构地区：[1]上海市第一人民医院分院神经内科,上海200081

出　　处：《同济大学学报（医学版）》2016年第6期101-105,共5页Journal of Tongji University(Medical Science)

基　　金：上海市虹口区卫计委脑卒中专项基金((2015)29)

摘　　要：目的探讨短暂视觉障碍(transient visual disorders,TVDs)亚型与短暂缺血发作(transient ischemic attack,TIA)主要致病因素及预后判断的关系。方法对2010年10月至2014年4月在上海市第一人民医院分院神经内科急诊,确诊的538例TIA患者采用磁共振和超声等方法判断TIA病因,采用标准化的问卷调查表记录TVDs的主要亚型包括短暂单侧全盲(transient monocular blindness,TM B)、同向外侧偏盲(homonymous lateral hemianopia,HLH)、孤立双盲(lone bilateral blindness,LBB)、双侧正视觉现象(bilateral positive visual phenomena,BPVP)和复视(diplopia)。组合使用多种统计方法分析TVDs各亚型与TIA发病原因和高风险再发危险因素的相关性,以此判断患者预后。结果共计175名(32.5%)TIA患者发生TVDs,其中TMB是最常见的视觉障碍。HLH患者中房颤发生率较高,TM B意味着颅外动脉粥样硬化/闭塞或房颤的可能性更大;复视与颅外动脉疾患和非房颤所致心源性栓塞有统计学关联;LBB多代表颅内动脉疾患。36个月随访时间终点时,HLH、复视、LBB、TM B和BPVP患者中的卒中病例发生率分别为30.3%、21.2%、17.6%、10.4%和5.0%,各组间比较差异有统计学意义(P<0.05)。无论是否发生TVDs,患者总体死亡率无明显差异。结论鉴别TVDs亚型可用于快速判断TIA病因和预后评估,在国内现有急诊条件和医疗环境下具有重要临床意义。Objective To determine whether subtype identification of transient visual disorders （TVDs） contributes to rapid confirmation of different pathogenesis and prognosis assessments of transient ischemic attack （TIA）. Methods A cohort of 538 patients with TIA diagnosed between October 2010 and April 2014 in our hospital were included in the study. Patients with transient visual disorders were identified and classified as 5 subtypes： transient monocular blindness （TMB）,homonymous lateral hemianopia （HLH）, lone bilateral blindness （LBB）, bilateral positive visual phenomena（BPVP） and diplopia. Combined analyses of statistical methods were used to determining the pathogenesis and prognosis of TIA. Results Totally 175 cases （32.5%） had transient visual disorders, and TMB was the most frequent TVDs. Atrial fibrillation（AF） was found most frequently in patients with HLH, TMB was frequently associated with extracranial atherosclerotic stenosis or AF. Diplopia was closely related to extracranial atherosclerotic stenosis or other major cardiac sources of embolism, while LBB was related to intracranial atherosclerotic stenosis. The stroke event rate was 30.3% in HLH, 21.2% in diplopia, 17.6% in LBB, 10.4% in TMB and 5.0% in BPVP with statistical differences. Conclusion Identification of subtypes of TVDs contributes to rapid confirmation of different pathogenesis and prognosis assessments of TIA with a significantly clinical value.

关 键 词：短暂缺血发作 短暂视觉障碍 卒中 动脉粥样硬化 心房颤动 

分 类 号：R741[医药卫生—神经病学与精神病学]