短暂性脑缺血发作短期预后与脑动脉狭窄特征的相关性研究

目的 研究短暂性脑缺血发作（TIA）患者首发症状后90 d预后与脑供血动脉的狭窄特征包括狭窄程度、分布部位及斑块性质的关系.方法 对87例首发TIA住院患者进行回顾性分析,观察颅脑动脉病变情况,对其进行90 d随访.根据患者预后情况分为稳定组、频发组、脑梗死组,收集数据进行统计分析.结果 87例患者失访8例,完成随访的79例TIA患者中稳定组34例（43.0%）,频发组37例（46.8%）,脑梗死组8例（10.2%）.3组患者血管病变特点：狭窄血管共135条,稳定组血管狭窄构成比：轻度77.4%（24/31）,中度16.1%（5/31）,重度3.2%（1/31）,闭塞3.2%（1/31）;频发组血管狭窄构成比;轻度73.9%（48/65）,中度10.8%（7/65）,重度4.6%（3/65）,闭塞10.8%（7/65）;脑梗死组血管狭窄构成比：轻度56.4%（22/39）,中度10.3%（4/39）,重度15.4%（6/39）,闭塞17.9%（7/39）.中轻度血管狭窄构成比以稳定组最高,其次为频发组,脑梗死组最低.重度和闭塞血管构成比脑梗死组最高,其次为频发组,稳定组最低.相关分析结果显示TIA预后与血管狭窄程度呈正相关（r=0.199,P=0.021）.发现斑块117个,稳定组斑块构成比：钙化斑51.4%（18/35）,混合斑34.3%（12/35）,软斑14.3%（5/35）;频发组斑块构成比：钙化斑23.5%（12/51）,混合斑47.1（24/51）,软斑29.4%（15/51）;脑梗死组斑块构成比：钙化斑12.9%（4/31）,混合斑48.4%（15/31）,软斑38.7%（12/31）.中稳定组钙化斑构成比最高,其次为频发组,脑梗死组最低.混合斑和软斑脑梗死组所占比例最高,其次为频发组,稳定组最低.相关分析显示TIA与血管斑块性质呈正相关（r=0.341,P=0.001）.稳定组前循环血管狭窄以颈总动脉38.9%（7/18）最多见,后循环以椎动脉颅内段30.8%（4/13）多见;频发组和脑梗死组前循环狭窄以大脑中动脉32.5%（13/40）、36.8%（7/19）最多见,后循环以椎动脉颅外段36.0%（9/25）、35.0%（7/20）多见,但差异无统计学意义（P＞0.05）.结论 TIA预后与脑供血动脉的狭窄程度及斑块性质有关,狭窄程度越重、斑块性质越不稳定,预后越差.

Correlation between prognosis of short-time transient ischemic attack and cerebral artery stenosis

Objective To explore the correlation between prognosis of transient ischemic attack（TIA） with the characteristic of cerebral arteries stenosis and plaque. Methods A retrospective clinical analysis was performed on the clinical data from 87 patients with the first time attack of TIA. The patients were divided into favorable prognosis group, frequent attacks group and cerebral infarction group. Results Favorable group had 34 cases, frequent attacks group had 37 cases and cerebral infarction group had 8 cases. In favorable group, there were mild stenosis 77.4%（24/31） position and calcific plaque 51.4%（18/35）; the least was cerebral infarction group（mild stenosis 56.4%, calcific plaque 12.9%）. The severe stenosis, occlusion and soft plaque in favorable group was least（severe stenosis 3.2%, occlusion 3.2%, soft plaque 14.3%）; the highest was cerebral infarction group（severe stenosis 15.4%, occlusion 17.9%, soft plaque 38.7%）. The positive rate nature of plaques and the stenosis degree of artery were significantly different among the three groups（all P〈0.05）. The CCA was the frequent stenosis in anterior circulation at favorable group38.9%（7/18], the ICVA was the frequently stenosis in posterior circulation at favorable group 30.8%（4/13）],the MCA was the frequently stenosis in posterior circulation between frequent attacks group 32.5%（13/40）] and cerebral infarction group 36.8%（7/19）]; the ECVA was the frequently stenosis in posterior circulation between frequent attacks group 36.0%（9/25）]and cerebral infarction group 35.0%（7/20）]（P〉0.05）. Conclusions In this study the short time prognosis of TIA is associated with the stenosis degree of artery and nature of plaques. The severe stenosis and unstable plaque suggest poor prognosis.