短暂性脑缺血发作进展为脑梗死的相关因素分析

目的探讨短暂性脑缺血发作(TIA)短期(1周)内进展为脑梗死的的危险因素。方法纳入54例短期内进展为脑梗死的TIA患者(进展组)和同期住院的54例未进展为脑梗死的TIA患者(对照组),在年龄、性别、高血压病史、糖尿病病史、卒中家族史、吸烟史、饮酒史、TIA发作次数、持续时间、入院时高血糖、入院后高血压、高血脂、纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)、颈动脉斑块、颈动脉狭窄等16个因素进行t检验或χ~2检验,并用多元Logistic回归分析确定TIA进展为脑梗死的危险因素。结果2组间高血压病史、糖尿病病史、TIA发作次数、持续时间、入院时高血糖、hs-CRP、颈动脉斑块、颈动脉狭窄等8个因素差异有统计学意义(P<0.01或P<0.05),进一步多元Logistic回归分析显示,TIA发作次数、高血压病史、颈动脉斑块、持续时间、hs-CRP、糖尿病病史与脑梗死相关,是TIA短期内进展为脑梗死的主要危险因素。结论存在脑血管病危险因素的患者容易进展为脑梗死,TIA短期内进展为脑梗死是多种因素多种机制共同作用的结果。     

高血压对TIA颈动脉粥样硬化和ABCD评分的影响

目的观察高血压对短暂性脑缺血发作(TIA)患者颈动脉粥样硬化和ABCD评分的影响。方法选择35例TIA合并高血压患者、33例TIA不合并高血压患者和32例非脑血管病非高血压患者进行对照分析,均测量血压、行颈动脉彩色多普勒超声检查,对TIA组患者均行ABCD评分。结果TIA组颈动脉内中膜厚度(intima-media thickness,IMT)和不稳定斑块发生率明显高于对照组,以合并高血压组增加最为明显,TIA合并高血压组ABCD评分明显高于非高血压组。结论高血压是动脉粥样硬化的重要危险因素,高血压加速TIA颈动脉粥样硬化进程,并进一步增加卒中的风险。     

短暂性脑缺血发作进展为脑梗死危险因素分析

目的:探讨短暂性脑缺血发作(TIA)进展为脑梗死的危险因素。方法:选取129例TIA患者,其中32例在6个月内最终进展为脑梗死(脑梗死组),97例病情未进展(TIA组);对2组临床资料进行对比,并将所得数据进行统计学分析。结果:脑梗死组有高血压史、颈动脉不稳定斑块、糖尿病史、发作持续时间≥30 min和发作次数≥3次,均高于TIA组(P<0.05～P<0.01)。2组患者性别、有无吸烟史和有无冠心病史差异均无统计学意义(P>0.05)。脑梗死组患者年龄大于TIA组(P<0.05)。而2组患者空腹血糖、三酰甘油、胆固醇、低密度脂蛋白和血尿酸水平差异均无统计学意义(P>0.05)。结论:TIA发作持续时间长、发作次数多,尤其有高血压病、糖尿病、高龄、颈动脉不稳定斑块者短期内进展为脑梗死的危险性较高。     

159例短暂性脑缺血发作患者早期预后及其影响因素分析

目的 分析短暂性脑缺血发作患者的早期预后及其影响因素.方法 方便收集2013年3月—2015年10月该院收治的159例短暂性脑缺血发作(TIA)患者,以住院7 d为观察终点,7 d内是否进展为脑梗死分为梗死组和非梗死组,采用Pearson单因素分析与多元Logistic回归分析,分析两组间的相关危险因素.结果 ABCD2评分与TIA后发生脑梗死的比例成正相关,低危组15.1%,中危组31.5%,高危组84.8%.单因素分析示年龄、高血压、糖尿病、冠心病、颈动脉硬化斑块,高同型半胱氨酸血症为有统计学意义的影响因素.多元Logistic回归分析显示年龄、高血压、糖尿病、颈动脉硬化斑块为TIA进展至脑梗死的独立危险因素.结论 ABCD2评分高者TIA进展至脑梗死风险高.年龄、高血压、糖尿病、颈动脉硬化斑块为TIA进展至脑梗死的危险因素.     

慢性颅内外血管狭窄-TIA患者卒中再发的危险因素

短暂性脑缺血发作（Transient ischemic attack，TIA）为脑梗死的先兆症状和发生脑梗死的重要危险因素之一，约1／3的TIA患者在1年内进展为卒中。伴有颈动脉狭窄的TIA患者，如果首发症状为ICA系统TIA，2年内病灶同侧卒中的危险率高达50％，如果首次缺血症状为视网膜TIA，卒中危险率为17％，而LL高达50％的TIA患者在病后2个月内有反复TIA发作。而再发卒中是导致患者死亡、致残和高额经济负担的重要原因，所以卒中的防治关键是治疗TIA。     

186例TIA型脑梗死的临床特点分析

目的:对短暂性脑缺血发作(TIA)型脑梗死的临床特点进行分析。方法:对186例TIA型脑梗死病人危险因素、临床表现、影像学资料等进行分析。结果:TIA型脑梗死以高血压、糖尿病、血脂异常为主要危险因素,检出颈动脉斑块152例(81.7%),颈动脉狭窄55例(29.6%),经颅多普勒(TCD)检测异常161例(86.6%),血流速度增快型110例。结论:血管狭窄是TIA型脑梗死反复发作的主要原因,此类病人预后相对良好提示缺血耐受的存在。     

短暂性脑缺血发作进展至脑梗死临床情况分析

目的 探讨短暂性脑缺血发作(TIA)发展至脑梗死的危险因素及临床干预的影响.方法 对160例TIA患者的临床资料进行分析.结果 发作频率在3次/d以上、发作持续时间超过30min、神经功能缺损评分严重的病例、或伴有高血压、颈动脉斑块、冠心病等心脏病变、糖球病或高酯血症等是TIA短期内进展至脑梗死的危险因素.积极进行抗血小板聚集、抗凝或降纤等治疗的患者发展至脑梗死的比例明显减少.结论 TIA进展至脑梗死是多因素、多种机制共同作用的结果,TIA反复发作、发作持续时间较长以及存在脑血管病危险因素的患者容易发生脑梗死.对TIA患者积极抗血栓治疗能明显降低脑梗死的危险性.     

短暂性脑缺血患者颈动脉粥样硬化及相关危险因素分析

目的探讨短暂性脑缺血发作(TIA)患者颈动脉粥样硬化(AS)斑块发生与年龄、高血压等危险因素的关系.方法对109例TIA患者的颈动脉超声检查结果及动脉粥样硬化的危险因素采用Logistic回归分析法进行分析.结果TIA患者颈动脉斑块的发生率为60.55%,斑块的发生与年龄、高血压史、胆固醇水平、ApoE-B水平相关.青年TIA患者已有早期动脉硬化-内膜-中膜厚度(IMT)的改变.动脉粥样硬化斑块以颈动脉球部多发,以等回声、不均回声斑块为主.结论TIA患者的颈动脉AS发生率极高,斑块的发生与年龄、高血压、血脂呈正相关.     

高频超声对颈动脉斑块与脑卒中危险因素相关性的分析

目的高频超声诊断颈动脉斑块类型及相关危险因素与缺血性脑卒中（Ischemic stroke,IS）发病的相关性分析。方法将患者分为缺血性脑卒中与非缺血性脑卒中两组;运用高频超声对284例患者行颈动脉检测,利用高频超声将斑块分为：扁平型、透声型、50%以上为透声型、50%以上为不透声型、不透声型、强回声伴声影型、溃疡型;同时记录两组患者脑卒中的高血压、糖尿病、冠心病、短暂性脑缺血发作TIA、高血脂、吸烟等危险因素。结果 1.短暂性脑缺血发作TIA的患者的不稳定斑块发生率明显增高,差别有统计学意义（P〈0.05）;2.稳定斑块的发生率明显高于不稳定型斑块,但其TIA差别无统计学意义（P〉0.05）;3.高血压、糖尿病、冠心病、高血脂、吸烟各危险因素与稳定斑块及不稳定斑块差别均无统计学意义（P〉0.05）。结论高频超声能够准确诊断颈部斑块类型,对预防缺血性脑卒中有指导意义。     

短暂性脑缺血发作相关危险因素分析

目的:分析短暂脑缺血发作(TIA)转化为脑部病变的危险因素。方法:对2004年1月～2011年7月我科住院的TIA患者资料进行统计分析其,年龄、性别、BMI、吸烟史、嗜酒史、既往有无颅内血管事件病史、先前脑卒中病史、血压、肢体无力、言语障碍、症状持续时间≥1h、影像学异常(头颅CT显示缺血性卒中病灶)、心房颤动、颈动脉超声斑块、高血脂、溶血磷脂酸、C反应蛋白、冠心病、糖尿病、心功能不全等因素与90天内缺血性脑卒中转化的相关性。结果TIA后缺血性脑卒中大多发生于急性期(即14d内)在单因素Logistic回归分析中心功能不全、BMI>25kg/m2、心房颤动、既往颅内血管事件病史、CT显示缺血性卒中、颈动脉超声斑块为缺血.性脑卒中转化的的危险因素(P<0.05):多因素非条件的Logistic回门分析结果显示肢体无力、心功能不全、既往颅内血管事件病史、颈动脉超声斑块与TIA后14d发生缺血性脑卒中有关;症状持续时间≥1h、言语障碍、肢体无力、BMI≥525kg/m2、心功能不全、既往颅内血管事件病史、CT显示缺血性卒中、颈动脉超声斑块与TIA后90d发生脑卒中有关,α=0.05水平为界。结论:TIA后缺血性脑卒中大多发生在急性期,在TIA发生后就对患者进行积极有效的相关治疗对预防TIA转化为缺血性脑卒中有重要意义。     

多发性与单发性脑梗死的危险因素比较分析

目的探讨多发性脑梗死与单发性脑梗死的相关危险因素的差异及其临床意义。方法前瞻性选择我院2010年8月-2011年12月收治的152例缺血性脑卒中患者,根据CT及MRI影像学评价分为两组,其中83例多发性脑梗死患者纳入A组,69例单发性脑梗死患者纳入B组。收集两组患者的临床资料并进行单因素比较。将有统计学意义的因素纳人多因素Logistic分析。结果两组患者在患糖尿病和高血压、TIA、心房颤动及重度颈动脉狭窄病史方面存在统计学差异（P〈0．05）;非条件Logistic多因素分析表明高血压、糖尿病、TIA史和心房颤动是MCI的独立危险因素（OR=1．29、1．44、1．20、1．58）。结论MCI与SCI患者具有不同的发病危险因素,其中高血压、糖尿病、TIA史和心房颤动是MCI的独立危险因素。     

Is there any relation between ischemic cerebrovascular disease and extracranial internal carotid stenosis?

OBJECTIVES: To confirm the existence of plaque or stenosis in the extracranial carotid arteries of patients with transient ischemia attack (TIA) or stroke, and to analyze the prevalence of extracranial carotid atherosclerotic stenosis, as well as the relation between the hemispheric symptoms and the degree of stenosis. METHODS: From January 1995 to March 1996, 188 patients underwent routine carotid artery duplex scan at Zhongshan Hospital, Shanghai. Of the 188 patients, 134 had TIA or stroke in the carotid territory during the previous 12 months, 54 were with peripheral arterial occlusive disease (PAOD). All patients were divided into three groups, that is, stroke/TIA group (Group 1, n = 128), PAOD group (Group 2, n = 36), and stroke/TIA + PAOD group (Group 3, n = 24). The classification of degree of stenosis in our study was as same as that applied by North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST). RESULTS: A total of 376 internal carotid arteries were examined by duplex scanning in this study. The prevalence of severe stenosis in the three groups was 12.5%, 8.3% and 37.5% separately. The severity of stenosis had a close relation with patients' symptoms (P < 0.01). CONCLUSIONS: Patients with stroke or TIA have atherosclerotic plaques in the carotid arteries. The prevalence of extracranial carotid stenosis is comparable to that reported in the literature. PAOD may be helpful to identify patients at high risk for severe carotid stenosis. Carotid duplex scanning should be performed as a routine examination for patients with stroke, TIA, and PAOD.     

短暂性脑缺血发作进展至脑梗死的相关因素分析

目的:探讨短暂性脑缺血发作(TIA)发展至脑梗死的危险因素及临床干预的影响。方法:对220例TIA患者的临床资料进行分析。结果:发作频率在3次/d以上、发作持续时间超过30 min、神经功能缺损评分严重的病例、或伴有高血压、糖尿病或高血脂症是TIA短期内进展至脑梗死的危险因素。积极进行抗血小板聚集、抗凝或降纤治疗的患者发展至脑梗死的比例明显减少。结论:TIA反复发作、发作持续时间较长以及存在脑血管病危险因素的患者容易发生脑梗死。对TIA患者积极抗血栓治疗能明显降低脑梗死的危险性。     

头颈CTA联合扫描及脑灌注成像(CTP)在短暂性脑缺血发作(TIA)的价值

目的评价MSCT平扫、头颈CTA以及颅脑灌注(CTP)对TIA患者的应用价值。方法选取符合临床诊断标准的TIA患者30例,所有病例均进行头颈CT平扫、CTA扫描,颅脑CTP成像,获得相关图像数据。结果本组椎基动脉系统TIA共10例,其中8例CTP脑灌注异常,CTA发现7例有椎基动脉粥样斑块和管腔狭窄。颈内动脉系统TIA共20例,其中15例CTP脑灌注异常,CTA发现14例有颈内动脉系统粥样斑块并血管狭窄。结论通过64层螺旋CT及时而方便地检查出头颈动脉狭窄或闭塞的存在及斑块性质,并分析软斑块发生的相关性因素,了解相应脑血流动力学改变,不仅能预测卒中风险,对TIA患者的早期发现及后续的治疗有非常重要的临床意义。     

Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group

OBJECTIVE--To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (greater than 50%) ipsilateral internal carotid artery stenosis. DESIGN--Prospective, randomized, multicenter trial. SETTING--Sixteen university-affiliated Veterans Affairs medical centers. PATIENTS--Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial. OUTCOME MEASURES--Cerebral infarction or crescendo transient ischemic attacks in the vascular distribution of the original symptoms or death within 30 days of randomization. INTERVENTION--Carotid endarterectomy plus the best medical care (n = 91) vs the best medical care alone (n = 98). RESULTS--At a mean follow-up of 11.9 months, there was a significant reduction in stroke or crescendo transient ischemic attacks in patients who received carotid endarterectomy (7.7%) compared with nonsurgical patients (19.4%), or an absolute risk reduction of 11.7% (P = .011). The benefit of surgery was more profound in patients with internal carotid artery stenosis greater than 70% (absolute risk reduction, 17.7%; P = .004). The benefit of surgery was apparent within 2 months after randomization, and only one stroke was noted in the surgical group beyond the 30-day perioperative period. CONCLUSIONS--For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated.     

Stroke risk factors,subtypes, and 30-day case fatality in Abuja,Nigeria

Background:

Stroke is the second leading cause of death and the leading cause of adult disability worldwide. A better understanding of stroke risk factors and outcome may help guide efforts at reducing the community burden of stroke. This study aimed to understand stroke risk factors, imaging subtypes, and 30-day outcomes among adult Nigerians.

Materials and Methods:

We prospectively recruited all patients presenting with acute stroke at the National Hospital Abuja between January 2010 and June 2012. We assessed clinical and laboratory variables, as well as brain computerized tomography, magnetic resonance imaging, and carotid Doppler ultrasound scans. We also assessed case fatality and functional outcome at 30 days after stroke.

Results:

Of 272 patients studied, 168 (61.8%) were males. Age at presentation (mean ± standard deviation) was 56.4 ± 12.7 years in males and 52.9 ± 14.8 years in females (P = 0.039). Neuroimaging was obtained in 96.7% patients, revealing cerebral infarction (61.8%), intracerebral hemorrhage (ICH) (34.8%), and subarachnoid hemorrhage (SAH) (3.4%). Carotid plaques or stenosis ≥50% were detected in 53.2% patients with cerebral infarction. Stroke risk factors included hypertension (82.7%), obesity (32.6%), diabetes (23.5%), hyperlipidemia (18.4%), atrial fibrillation (9.2%), and cigarette smoking (7.7%). At 30 days after stroke, case-fatality rate was 18.8%, whereas modified Rankin Scale (mRS) scores for cerebral infarction, ICH, and SAH were 3.71, 4.21, and 4.56, respectively. Atrial fibrillation, a previous stroke, and age older than 50 years were all associated with worse mRS scores at 30 days.

Conclusion:

Although hypertension, obesity, diabetes mellitus, and atrial fibrillation were important stroke risk factors, in many patients, these were detected only after a stroke. While the commonest stroke subtype was cerebral infarction, observed in almost two-third of patients, SAH was associated with the highest case-fatality rate at 30 days of 44.4%. Larger population-based studies may provide additional data on stroke incidence and outcome among Nigerians.     

基于CISS分型的复发性脑梗死的高危因素及其与亚型的相关性

目的 分析基于中国缺血性脑卒中亚型(CISS)分型的脑梗死1年内复发的危险因素及其与各亚型的相关性,为临床干预提供依据.方法 收集1 446例脑梗死及随访1年内复发患者,进行CISS分型,同期调查并分析各亚型中危险因素的分布状况.运用多元回归方法分析不同脑梗死亚型患者各危险因素与1年内梗死复发的独立相关性.结果 1 446例患者中,其中大动脉粥样硬化(LAA)亚型741例, 穿支动脉病变(PAD)亚型501例,心源性栓塞(CS)亚型119例,病因不明(UE)亚型55例,其他(OE)亚型30例.1年内梗死复发125例,其中LAA亚型61例,PAD亚型38例,CS亚型21例,UE亚型5例,OE亚型0例.多元回归分析显示,颈动脉中度狭窄、颈动脉重度狭窄与LAA亚型1年内梗死复发独立相关(OR=6.178、9.016,95% CI:2.262~11.749、3.023~15.172,P=0.012、0.004);高血压与PAD亚型1年内梗死复发独立相关(OR=1.786,95% CI:1.102~2.942,P=0.013);年龄、心房纤颤与CS亚型1年内脑梗死复发独立相关(OR=1.031、6.179,95% CI:1.012~1.051、1.045~35.128,P=0.003、0.032).结论 颈动脉中重度狭窄是LAA亚型复发的独立危险因素,高血压是PAD亚型复发的独立危险因素,年龄、心房纤颤是CS亚型复发的独立危险因素.     

脑卒中复发影响因素的Cox回归分析

目的探讨脑卒中复发状况及其主要影响因素。方法以1824例脑卒中新发病例为研究对象,排除短暂性脑缺血(TIA)和蛛网膜下腔出血,随访患者的复发情况,调查影响复发的各种因素。随访时间分别为3、6个月和1年。应用Cox比例风险回归模型对影响脑卒中复发的各种因素进行单因素和多因素分析。结果 1824例新发脑卒中,受访病例1651例(90.52%),失访病例173例(9.48%)。失访者和受访者差异无统计学意义(P>0.05)。脑卒中1年复发比例为15.26%。高血压史、TIA史、脑卒中家族史、总胆固醇、低密度脂蛋白是脑卒中复发的危险因素。结论防治脑卒中复发应加强脑卒中患者的高血压、TIA、血脂水平的监测和控制。