中老年人短暂性脑缺血发作的危险因素及预后分析

发布时间：2018-04-09 11:44

本文选题：中老年　切入点：短暂性脑缺血　出处：《郑州大学》2014年硕士论文

【摘要】：背景与目的短暂性脑缺血发作（Transient IschemicAttack TIA)是指由于脑或视网膜局灶性缺血所致的、不伴急性梗死的短暂性神经功能障碍。临床症状一般持续10-20min,多在1h内缓解，最长不超过24h，不遗留任何神经功能缺损症状，CT或MRI检查无任何责任病灶。中老年人为TIA的高发人群，如果这类人群发生TIA的危险因素不能得到有效的预防和控制，极有可能进展为脑卒中，影响患者的生活质量。因此，分析中老年TIA的危险因素，同时探讨ABCD3评分法应用于预测TIA后早期进展为脑卒中风险评估中的临床价值是本文的主题。目的是降低TIA进展为脑卒中的发生率，以减少脑卒中的致残率，为临床上对中老年TIA的诊疗提供依据。方法: 选取2011年2月至2014年1月期间在郑大二附院和郑大四附院住院治疗的138例短暂性脑缺血发作患者作为观察对象，所有患者的年龄在均在45-80岁之间。将所选取的138例患者根据ABCD3评分表进行评分，并分为低危、中危、高危三组，记录所有患者7d内脑梗死的发生率。对影响患者TIA发作的各种危险因素进行分析，应用ABCD3评分法对所有患者7d内脑梗死的发生率及影响患者早期进展为脑梗死的相关危险因素进行分析，并应用统计学方法进行比较。统计学方法：用SPSS17.0统计学软件对上述数据进行处理，P0.05表示差异具有统计学意义。结果 1.低、中、高危组男性患者所占比例分别为76.1%（30/46）、64.81%(35/54)、60.5%(23/38)，年龄≥60岁的患者中，低危组所占比例为10.9%(5/46)，中危组所占比例为75.9%(41/54)，高危组所占比例为63.2%(24/38)； 2.应用Logistic回归分析各个危险因素对患者的影响大小依次为，高血压病、高脂血症、吸烟史，糖尿病、高血压合并糖尿病、高血压合并冠心病、房颤、酗酒史、TIA史； 3.颈动脉狭窄程度、血清同型半胱氨酸水平高低、C-反应蛋白水平高低与TIA的危险分层呈正相关（P0.05)； 4.低危、中危、高危组患者比较颈动脉内膜-中层增厚、软斑、混合斑块，具有统计学差异（P0.05),而硬斑三组比较无差异（P0.05）； 5.低、中、高危组TIA后7d内脑梗死的发生率进行比较，结果表明，中危组及高危组与低危组比较有差异（P0.05)，高危组与中危组比较有差异（P0.05)，具有有统计学意义； 6.ABCD3评分为≤3分的患者7d内脑梗死的发生率为2.17%（1/46)，ABCD3评分4-5分的患者7d内脑梗死的发生率为14.81%(8/54)，ABCD3评分6-9分的患者7d内脑梗死的发生率为27.78%(10/36)，通过Spearman相关分析得出，ABCD3评分值与7d内脑梗死的发生率呈正相关, P0.05,具有统计学意义； 7.不同危险因素对患者TIA后早期发生脑梗死的Logistic回归分析结果为，糖尿病、双重TIA史、TIA症状持续时间≥60min,TIA症状发作频率≥3次/d，颈动脉中重度狭窄（≥50%）的OR值均1，与TIA后早期发生脑梗死具有相关性。结论 1．男性、年龄≥60岁、动脉粥样硬化、高血压病、高脂血症、吸烟史、糖尿病是中老年TIA主要的危险因素； 2．颈动脉狭窄程度、血清同型半胱氨酸水平、C-反应蛋白水平与中老年TIA的病情严重程度呈正相关； 3.ABCD3分值越高，，患者TIA后早期脑梗死的发生率越高；ABCD3评分对TIA后早期发生脑卒中的风险评估有较高的临床价值； 4.症状持续时间≥60min、症状发作频率≥3次/d、颈动脉狭窄≥50%、糖尿病、双重TIA史是TIA后早期发生脑梗死的重要且独立的危险因素。
[Abstract]:Background and purpose
Transient ischemic attack (Transient IschemicAttack TIA) is due to cerebral or retinal focal ischemia, transient neurological dysfunction is associated with acute infarction. The clinical symptoms usually last 10-20min, more ease in 1H, the longest no more than 24h, without any residual neurological deficit symptoms, CT or MRI. No liability for any lesion.
The high-risk population of elderly TIA, if not the risk factors in this population of TIA have been effective prevention and control, is likely to progress to stroke, affecting the quality of life of patients. Therefore, the analysis of risk factors in elderly patients with TIA, and explore the application of ABCD3 scoring method to predict the progress of clinical value for early after TIA stroke risk assessment is the subject of this article. The purpose is to reduce the TIA in the incidence of stroke, in order to reduce the morbidity of stroke, and provide clinical basis for the diagnosis and treatment of TIA in elderly.
Method:
During the period from February 2011 to January 2014 in the four Affiliated Hospital of Zhengzhou University Affiliated Hospital and the Zheng Daer hospital 138 cases of transient ischemic attack in the treatment of patients as the object of observation, all patients in all age in 45-80 years old. 138 cases of the patients selected according to the ABCD3 scale score, and divided into low risk, medium risk, and three high risk group the incidence, records of all patients with cerebral infarction in 7d. The influence factors of various risk of seizures in patients with TIA were analyzed, and the incidence rate of patients with early progression to the related risk factors of cerebral infarction were analyzed for all patients of cerebral infarction in 7d using ABCD3 score, and statistical methods were used for comparison.
Statistical method: the above data were processed with SPSS17.0 statistics software, and P0.05 indicated that the difference was statistically significant.
Result
1., in the high risk group of male patients accounted for 76.1% (30/46), 64.81% (35/54), 60.5% (23/38), 60 years of age or older patients in the low-risk group accounted for 10.9% (5/46), medium risk group accounted for 75.9% (41/54), high risk group accounted for 63.2% (24/38);
2., Logistic regression analysis was used to analyze the impact of various risk factors on patients, followed by hypertension, hyperlipidemia, smoking history, diabetes, hypertension and diabetes, hypertension and coronary heart disease, atrial fibrillation, alcoholism and TIA history.
3. the degree of carotid stenosis, the level of serum homocysteine, the level of C- reactive protein was positively correlated with the risk stratification of TIA (P0.05).
4. low risk, middle risk group and high-risk group had statistically significant difference between carotid artery intima media thickness, soft plaque and mixed plaque (P0.05), while hard plaque had no difference between the three groups (P0.05).
5., the incidence of cerebral infarction within 7d in the low, middle and high risk group after TIA was compared. The results showed that there was a difference between the middle risk group and the high-risk group (P0.05), and there was a significant difference between the high-risk group and the middle risk group (P0.05).
The 6.ABCD3 score is less than or equal to 3 points in patients with cerebral infarction in 7d incidence rate was 2.17% (1/46), ABCD3 score of 4-5 patients with cerebral infarction in 7d incidence rate was 14.81% (8/54), ABCD3 score of 6-9 patients with cerebral infarction in 7d incidence rate was 27.78% (10/36), by Spearman correlation analysis, ABCD3 score the value of 7D and in the incidence of cerebral infarction was positively related to P0.05, with statistical significance;
7. different risk factors for diabetes results, the incidence of cerebral infarction in early stage of Logistic patients after TIA regression, double TIA TIA history, duration of symptoms more than 60min, TIA is more than 3 times the /d symptom frequency, carotid artery stenosis (more than 50%) the OR value was 1, and the correlation of early cerebral infarction after TIA.
conclusion
1. men, aged 60 years, atherosclerosis, hypertension, hyperlipidemia, smoking history, diabetes is a major risk factor in the elderly TIA;
2. the degree of carotid artery stenosis, the level of serum homocysteine and the level of C- reactive protein were positively correlated with the severity of TIA in the middle and old age.
The higher the 3.ABCD3 score is, the higher the incidence of early cerebral infarction is after TIA. ABCD3 score has a high clinical value for the risk assessment of early stroke after TIA.
4. the duration of symptoms was more than 60min, more than 3 times the symptom frequency /d, carotid artery stenosis 50%, diabetes, double TIA history is an important and independent risk factors of early cerebral infarction after TIA.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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