短暂性脑缺血发作及小卒中早期进展的风险评估

目的分析短暂性脑缺血发作(TIA)及小卒中早期进展的危险因素。方法回顾性分析448例TIA或小卒中患者的入院资料,随访发病后7、30及90 d脑梗死发生率/复发率,通过Logistic回归分析TIA/小卒中随访期间新发脑梗死的危险因素。结果 TIA/小卒中患者7、30及90 d内新发脑梗死率分别为26.3%、30.1%、36.8%;直线回归分析显示ABCD2-DI评分与TIA/小卒中早期新发脑梗死呈正相关关系。Logistic回归分析TIA/小卒中患者7、30及90 d新发脑梗死的危险因素为:ABCD2-DI评分(OR值分别为2.23、3.03、5.24,P均0.05);糖化血红蛋白(OR值分别为1.71、2.56、3.44,P均0.05);双联抗血小板药物治疗(OR值分别为0.42、0.39、0.26,P均0.01);高敏CRP与7 d内新发脑梗死的OR值为1.58,P0.05。结论 ABCD2-DI评分、高敏CRP、糖化血红蛋白是TIA/小卒中患者早期进展的独立危险因素,使用双联抗血小板药物治疗可能是TIA/小卒中早期进展的保护因素。

Risk evaluation of early progression of transient ischemic attack and minor stroke

Objective To investigate the risk factors of early progression of transient ischemic attack （TIA） and minor stroke. Methods Data of 448 patients with TIA or minor stroke were analyzed retrospectively. The incidence or recurrence were followed up for 7,30 and 90 d. Logistic regressions were conducted to find the predictors of early progression in 7,30 and 90 d. Results 26. 3%, 30. 1% and 36. 8% of TIA or minor stroke patients developed into new stroke in 7,30 and 90 d after onset,respectively. Linear regression analysis showed the positive correlation between ABCD2-DI score and TIA or minor stroke patients who would develop into new stroke in early phase. Logistic regression analysis showed the OR value for the risks of TIA/minor stroke patients developing into new stroke respectively in 7,30 and 90 d after onset as follow： ABCD2-DI score （ OR = 2. 23, 3.03, 5.24, P 〈 0.05 ）, glycosylated hemoglobin （ OR = 1.71, 2. 56, 3.44, P 〈 0. 05 ）, dual-antiplatelet therapy （ OR = 0. 42, 0. 39, 0. 26, P 〈 0. 01 ）, high-sensitivity C- reactive protein（CRP） （ OR = 1.58, P 〈 0. 01, in 7 d）. Conclusion ABCD2-DI score, high-sensitivity CRP and glycosylated hemoglobin are independent risk factors and the dual antiplatelet therapy may be protective factors for the early progression in TIA/minor strokes.