衰弱对老年短暂性脑缺血发作患者预后的影响

目的 探讨衰弱对老年短暂性脑缺血发作患者预后的影响,并分析影响其预后的危险因素。方法 本研究为前瞻性队列研究,选取2017年1月—2020年1月在北京某三级甲等医院神经外科诊治的老年短暂性脑缺血发作患者。依据是否合并衰弱,分为衰弱前期组（102例）、衰弱组（47例）和未合并衰弱的60例患者为对照组。随访24个月,主要观察指标为脑血管事件发生情况,包括全因死亡、再发短暂性脑缺血发作。应用Kaplan-Meier生存分析和Log-rank检验比较3组患者的预后情况。应用Cox比例风险回归模型分析脑血管事件的相关因素。结果 209例患者中,衰弱组和衰弱前期组的B型利钠肽均高于对照组（P<0.05）。随访2年中共发生33例（15.8%）脑血管事件,包括5例（2.4%）全因死亡,28例（13.4%）再发。Kaplan-Meier生存分析和Log-rank检验结果提示,衰弱组复发或死亡率显著高于对照组（χ²=3.883,P=0.049）。采用多因素Cox比例风险回归模型,结果显示衰弱和心房颤动可能是发生脑血管事件的危险因素。结论 衰弱可增加老年短暂性脑缺血发作患者的再发短暂性脑缺血发作的发生风险,且为脑血管事件的危险因素。

Effect of Frailty on Prognosis in Elderly Patients with Transient Ischemic Attack

Objective To investigate the effect of frailty on the prognosis of elderly patients with transient ischemic attack (TIA) during 2-year follow-up and to analyze the risk factors of prognosis. Methods We conducted a longitudinal cohort study. Elderly patients with TIA who were treated in neurosurgery department of tertiary, grade-A hospital in Beijing from January 2017 to January 2020 were selected. According to whether combined with frailty or not, patients were divided into pre-frailty group (n=102), frailty group (n=47) and control group of 60 cases without frailty. After 24 months of follow-up, the main outcome indicators were the occurrence of cerebrovascular events, including all-cause death and recurrent TIA. Kaplan-meier survival analysis and log-rank test were used to compare the prognosis of the three groups. Cox proportional risk regression model was used to analyze the related factors of cerebrovascular events. Results In 209 patients, b-type natriuretic peptide in pre-frailty group and frailty group was higher than that in the control group (P<0.05). There were 33 cases (15.8%) of cerebrovascular events, including 5 cases (2.4%) of all-cause death and 28 cases (13.4%) of recurrence. Kaplan-meier survival analysis and log-rank test showed that the recurrence or mortality of frailty group was significantly higher than that of the control group (χ²=3.883, P=0.049). Multivariate Cox proportional risk regression model showed that frailty and atrial fibrillation were risk factors of cerebrovascular events. Conclusion Frailty can significantly increase the risk of recurrent TIA in elderly patients with TIA, and is a risk factor associated with cerebrovascular events.