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目的研究颈动脉狭窄性短暂性脑缺血(TIA)进展脑梗死的相关危险因素。方法选取2010年1月—2011年1月收入院并随访5年的颈动脉狭窄TIA病人129例为研究对象,根据具体情况分为试验组和对照组。试验组为继发脑梗死;对照组为无继发脑梗死。入院后,由经过训练的专人统计收集一般资料,包括年龄、性别、吸烟指数、高血压病、糖尿病;入院24h内常规抽血,检验生化指标。随访5年,统计发病情况、发病次数、时间及进展为脑梗死的时间及生化指标、格拉斯哥评分(GCS)、神经功能损害情况、日常生活量表等(ADL)情况并比较。结果试验组与对照组年龄、糖尿病、高血压病、吸烟指数、ABCD2评分比较均具有统计学意义(P<0.05),而在性别比较方面未见统计学意义(P>0.05)。入院时,两组血小板计数和纤维蛋白原比较具有统计学意义(P<0.05),其他生化指标均未见统计学意义(P>0.05)。对照组中度狭窄比例显著高于试验组(P<0.05);试验组颈动脉完全闭塞及重度狭窄病人比例显著高于对照组(P<0.05)。试验组入院时GCS评分、中重型神经功能缺损比率及出院时ADL量表得出的Ⅱ级预后比率及死亡率,均显著高于对照组(P<0.05)。试验组脑损伤程度重,预后差。结论颈动脉狭窄性TIA病人继发脑梗死的危险因素包括高龄、糖尿病、高血压、吸烟指数超过400、血小板计数及纤维蛋白原水平升高,同时颈动脉狭窄性TIA继发脑梗死,脑损伤重。
Objective To study the related risk factors of cerebral infarction in patients with carotid stenosis transient ischemic attack (TIA). Methods A total of 129 TIA patients with carotid stenosis who were admitted to our hospital from January 2010 to January 2011 and followed up for 5 years were selected as experimental subjects and divided into experimental group and control group according to the specific conditions. The experimental group was secondary to cerebral infarction; the control group was without secondary cerebral infarction. After admission, general statistics were collected by trained specialists, including age, gender, smoking index, hypertension and diabetes mellitus; blood samples were drawn routinely on admission for 24h and biochemical indicators were tested. After 5 years of follow-up, the incidence of disease, the frequency of onset, the time and the progress of the study were the time and biochemical indexes of cerebral infarction, Glasgow score (GCS), neurological impairment and daily life scale (ADL). Results The age, diabetes mellitus, hypertension, smoking index and ABCD2 score of the experimental group and the control group were all statistically significant (P <0.05), but not statistically significant (P> 0.05). At admission, platelet count and fibrinogen were statistically significant (P <0.05) and no other biochemical parameters were found (P> 0.05). The ratio of moderate stenosis in the control group was significantly higher than that in the experimental group (P <0.05). The proportion of patients with complete carotid artery occlusion and severe stenosis in the experimental group was significantly higher than that in the control group (P <0.05). The GCS score, the ratio of moderate to severe neurological deficits, and the ADL scale at discharge on admission in the study group were significantly higher than those in the control group (P <0.05). The experimental group suffered severe brain injury with poor prognosis. Conclusion The risk factors of secondary cerebral infarction in carotid stenosis TIA patients include senile diabetes, high blood pressure, smoking index more than 400, platelet count and fibrinogen level increase, and cerebral infarction secondary to carotid stenosis TIA and brain injury weight.