颈内动脉系统TIA患者短期内进展致脑梗死的危险因素分析  

Analysis of Risk Factors of cerebral Infarction Caused by Short-term Progression in TIA Patients

作　　者：杜威 DU Wei(Department of Neurology,Panjin Central Hospital,Panjin 124000,China)

机构地区：[1]辽宁省盘锦市中心医院神经内科,辽宁盘锦124000

出　　处：《中国医药指南》2022年第15期21-24,共4页Guide of China Medicine

摘　　要：目的探讨颈内动脉系统短暂性脑缺血发作(TIA)急性期(14 d内)进展成脑梗死的危险因素。方法回顾性分析2015年1月至2018年10月我院神经内科收治的颈内动脉系统TIA患者和以颈内动脉系统TIA形式起病的急性脑梗死患者共286例。对以上患者在1周内完善我院头部磁共振检查,根据头部磁共振弥散加权成像(DWI)检查结果分为两组:病例组(TIA进展成脑梗死组):DWI图像上定位区有责任病灶;对照组(TIA未进展成梗死组):未发现责任病灶。对以下内容进行分层研究:血胆固醇升高(≥6.00 mmol/L)、血三酰甘油升高(≥2.00 mmol/L)、血低密度胆固醇升高(≥2.60 mmol/L)、高同型半胱氨酸血症(年龄<60岁,>15 mg/L;年龄>60岁,>20 mg/L)、血浆纤维蛋白原(≥3.50 g/L);吸烟史:戒烟时间还不到6个月,或者每日吸烟1支或1支以上,且持续1年以上;饮酒史:每7天至少饮酒2次,摄入酒精量平均每次要大于24 g,且持续1年以上;TIA的发作次数:入院前1个月内发作次数≥3次;TIA的发作持续时间:≥30 min(对于多次发作的TIA患者,取其发作时间最长的一次作为评价时间);双侧颈动脉彩色多普勒超声检查:两组颅外段粥样硬化斑块检测情况比较分为无斑块、稳定斑块和易损斑块。结果病例组TIA的发作持续时间≥30 min、入院前1个月内TIA的发作次数≥3次、高同型半胱氨酸血症所占比例均低于对照组(P<0.05)。两组粥样硬化斑块检测情况比较:病例组患者中共54例检测出易损斑块,检出率为49.43%,对照组共59例检测出易损斑块,检出率为33.64%,病例组易损斑块检出率高于对照组(P<0.05)。Logistic多元回归分析:将TIA的发作持续时间≥30 min、入院前1个月内TIA的发作次数≥30次、高同型半胱氨酸血症及颈动脉粥样硬化斑块4个危险因素纳入SPSS20.0软件中,可以得出:TIA的发作持续时间≥30 min、入院前1个月内TIA的发作次数≥30次、高同型半胱氨酸血Objective To investigate the risk factors of cerebral infarction in acute phase(within 14 days)of transient ischemic attack(TIA)in the internal carotid artery system.Method A total of 286 patients with TIA in the internal carotid artery system and patients with acute cerebral infarction in the form of TIA in the internal carotid artery system were retrospectively analyzed from January 2015 to October 2018.For the above patients,the head magnetic resonance imaging in our hospital was completed within 1 week,and they were divided into two groups according to the results of head magnetic resonance diffusion-weighted imaging(DWI):case group(TIA progressed to cerebral infarction group):the localization area on DWI image was responsible lesions;control group(TIA did not progress to infarction group):no responsible lesions were found.Stratified studies were conducted on the following:elevated blood cholesterol(≥6.00 mmol/L),elevated blood triglycerides(≥2.00 mmol/L),elevated blood low-density cholesterol(≥2.60 mmol/L),high isotype cysteinemia(age<60 years,>15 mg/L;age>60 years,>20 mg/L),plasma fibrinogen(≥3.50 g/L);smoking history:less than time to quit smoking 6 months,or smoking 1 or more cigarettes per day for more than 1 year;history of drinking:drink at least 2 times every 7 days,the average alcohol intake is greater than 24 g each time,and last for more than 1 year;the number of attacks of TIA:the number of attacks≥3 times within 1 month before admission;the attack of TIA continues time:≥30 min(for TIA patients with multiple attacks,the longest attack time is taken as the evaluation time);bilateral carotid color Doppler ultrasonography:The detection of atherosclerotic plaque in the extracranial segment of the two groups was divided into no plaque,stable plaque and vulnerable plaque.Result The duration of TIA attacks≥30 min,the number of TIA attacks≥3 times within 1 month before admission,and the proportion of hyperhomocysteinemia in the case group were lower than those in the control group(P<0.05).

关 键 词：短暂性脑缺血发作 急性期脑梗死 危险因素 

分 类 号：R743.31[医药卫生—神经病学与精神病学]