短暂性脑缺血发作后短期发生脑梗死的风险分析

目的分析短暂性脑缺血发作（TIA）患者2～7天进展为脑梗死的危险因素。方法回顾性分析215例住院TIA患者的临床资料和磁共振成像检查结果，其中男138例，女77例，年龄17～88岁，平均（59．2±13．1）岁，按Johnston提出的7分ABCD^2评分法给予评分，观察TIA后2天和7天脑梗死的发生率，并分析影响TIA后短期发生脑梗死的危险因素。结果TIA后114例（53．0％）患者于7天内发生脑梗死，其中81例（37．9％）发生于2天内；ABCD^2评分与TIA后2天和7天脑梗死发生率之间呈直线相关关系，ABCD^2评分越高，脑梗死的发生率越高（r=0．977，0．980，均P〈0．01）；在年龄≥60岁、症状持续时间≥10分钟、高血压史、发作次数≥3次、磁共振弥散加权成像（DWI）异常、颅内动脉病变的患者中脑梗死的发生率明显增高（P〈0．05），抗血小板聚集治疗、抗凝治疗是TIA进展为脑梗死的保护因素。结论ABCIY评分有一定的临床价值及预测性，可作为一种临床预测TIA患者短期脑梗死发生的简单评估方法；ABCD^2评分结合磁共振成像表现能进一步提高预测的准确性。

Analysis on risks of cerebral infarction resulting from transient ischemic attack

Objective To investigate the risk factors influenting transient ischemic attaek（TIA） to evolve into cerebral infarction in short-term（onset 2-7 days）. Methods The clinical data and magnetic resonance image （MRI） findings of hospitalized TIA were analyzed retrospectively. 138 of 215 cases were males（64.20%） and 77 were females （35.8%）. Age ranged from 17-88 years old. The mean age was （59.2±13.1） years old. The ABCD^2 score was applied to all the patients. The 2-day and 7-day risk of cerebral infarction were analyzed. Results A total of 114 patients （53.0%） had cerebral infarction within 7 days after symptoms, among which 81 patients（37.9% ） occurred within 2 days. Linear correlation existed between ABCD^2 score and short-term risk of cerebral infarction in TIA patients（ r = 0. 977,0. 980,both P 〈0.01）. The higher the score was, the higher the incidence was. The occurrence was significantly higher in the patients older than 60 years old, the symptoms lasting over 10 minutes, hypertension, attack over 3 times, DWI lesions and intracal arterial occlusion（ P 〈0.05）. Conclusion The ABCD^2 score is simple and effective to predict short-term risk of cerebral infarction in the patients with TIA. Combination with MRI findings can improve the predictive accuracy of cerebral infarction after TIA.