TIA长期预后及二级预防依从性临床随访研究

发布时间：2018-06-29 09:09

本文选题：短暂性脑缺血发作 + 危险因素　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:短暂性脑缺血发作(transient ischemic attack,TIA)是脑梗死的危险因素之一,是神经内科的急症之一。TIA患者90d内进展为脑梗死的风险可达9%~17%,其中多数患者发生在TIA发病后最开始的2d内。TIA的危险因素较多,有研究表明TIA患者进展为脑卒中与症状持续时间、年龄、高血压、糖尿病、血脂异常、脑血管病家族史等有关。研究发现我国TIA患者二级预防尚欠规范,且依从性差。因此,本研究意在探讨TIA后长期内各危险因素与继发卒中的关系,观察TIA后脑卒中及TIA复发的发生率,观察患者TIA后二级预防依从性,从而为临床治疗和TIA预后提供依据。方法:选取147例TIA患者作为研究对象,详细登记患者的年龄、性别、吸烟史、饮酒史、既往高血压、冠心病、糖尿病病史及脑血管病家族史、临床症状、持续时间、发作次数、实验室检查结果、心电图结果、颈部血管超声检查结果、医学影像学检查结果(头CT或MRI)等基本资料,给予目前指南推荐规范治疗,出院时根据患者情况给予指南推荐二级预防方案。分别于患者入选后1个月、3个月、1年、2年、3年、4年、5年以电话或门诊复诊的方式进行随访,观察患者的用药情况、有无脑血管病事件的发生及发生时间。终点事件为出现新的脑血管病事件或患者因其他原因死亡。结果:研究期间共收集符合入组标准的147例患者,其中因心脏病原因死亡1例,CO中毒死亡1例,不明原因死亡1例,12例患者因电话变更失访。对剩余132例患者进行统计学资料分析,年龄22~78岁,平均58.63±11.52岁,男性95例(71.97%),女性37例(28.03%)。临床表现为颈内动脉系统症状患者97例(73.48%),其中表现为单个或单侧肢体无力伴言语不清27例,单肢或偏侧肢体无力37例,单纯言语不清12例,肢体感觉异常(伴或不伴肢体无力)21例;椎-基底动脉系统症状患者35例,其中表现为眩晕者26例,视物不清11例,意识不清2例,跌倒发作1例。颈内动脉系统TIA患者5年内发生脑梗死者20例,占20.62%,椎-基底动脉系统患者5年内发生脑梗死者1例,占2.86%,两者差别有统计学意义(χ2=6.065,P0.05)。132例患者中2天、7天、1月、3月、1年、2年、3年、4年、5年进展为脑梗死(cerebral infarction,CI)的分别为3例(2.27%)、5例(3.79%)、11例(8.33%)、12例(9.09%)、14例(10.61%)、16例(12.12%)、17例(12.88%)、19例(14.39%)、21例(15.91%),TIA反复发作的分别为21例(15.91%)、24例(18.18%)、30例(22.73%)、39例(29.55%)、43例(32.58%)、45例(34.09%)、46例(34.85%)、46例(34.85%)、49例(37.12%)。出院后1月、3月、1年、2年、3年、4年、5年二级预防应用药物的依从率:抗血小板药物依从率90.1%、85.8%、80.5%、72.4%、65.3%、60.1%、55.7%,降压药物依从率91.8%、88.3%、81.6%、74.2%、67.7%、60.2%、57.8%,降糖药物依从率94.2%、90.6%、86.5%、82.3%、79.1%、75.4%、72.2%,他汀类药物依从率83.2%、70.6%、52.4%、46.3%、40.1%、35.2%、28.8%。药物依从率随时间延长而逐渐降低,以他汀类药物依从性最差。出院患者口服抗血小板聚集药物、降压药、降糖药依从性与脑梗死发生有关系(P0.05),服药依从性越高,脑梗死发生率越低。TIA不良预后危险因素的单因素分析结果显示:年龄≥60岁、有脑血管病家族史、有高血压、糖尿病病史、颈动脉狭窄率≥50%、不同颈动脉系统TIA是TIA患者5年内发生脑梗死的有意义的危险因素(P0.05)。将上述各因素引入多因素Logistic回归分析以控制混杂因素的影响,得出:高血压、糖尿病、颈部血管狭窄、脑血管病家族病史为影响TIA不良预后的独立危险因素。结论:1年龄≥60岁、有脑血管病家族史、有高血压、糖尿病病史、颈部血管狭窄率≥50%、不同颈动脉系统TIA是TIA患者5年内发生脑梗死的有意义的危险因素;其中高血压病史、糖尿病病史、颈部血管狭窄率≥50%、脑血管病家族史是独立危险因素;2 TIA后5年内总梗死率随时间延长逐渐增高,且前1个月内增高较快,TIA进展为脑卒中风险较高;3 TIA后5年内TIA复发率随着时间的延长呈上升趋势;4 TIA患者离院后服药率随时间延长而逐渐降低,以他汀类服药率最低,药物种类组间比较差别有意义。出院患者口服抗血小板聚集药物、降压药、降糖药依从性与脑梗死发生有关系(P0.05),依从性越高,脑梗死发生率越低。
[Abstract]:Objective: transient ischemic attack (transient ischemic attack, TIA) is one of the risk factors for cerebral infarction. One of the acute symptoms of Neurology is one of the.TIA patients in.TIA. The risk of progression to cerebral infarction in 90d can reach 9%~17%, most of them occur at the beginning of TIA, and there are more risk factors for.TIA in 2D. There are studies showing that TIA patients are progressing. Stroke is associated with duration of symptoms, age, hypertension, diabetes, dyslipidemia, and family history of cerebrovascular disease. The study found that the two stage prevention of TIA patients in our country is still under standard and poor compliance. Therefore, this study aims to explore the relationship between the risk factors and secondary pawns in the long term after TIA, and to observe the incidence of stroke and the recurrence of TIA after TIA. The two levels of compliance after TIA were observed to provide basis for the clinical treatment and the prognosis of TIA. Methods: 147 cases of TIA patients were selected as the research object, and the age, sex, smoking history, drinking history, past hypertension, coronary heart disease, history of diabetes and the family history of cerebrovascular disease, clinical symptoms, duration, frequency of attack, and experiment were studied. The results of the room examination, the results of the electrocardiogram, the results of the cervical vascular ultrasound, the results of the medical imaging examination (head CT or MRI), were given the current guidelines for the recommended standard treatment, and the guidelines recommended two levels of prevention according to the patient's condition in the discharge. 1 months, 3 months, 1 years, 2 years, 3 years, 4 years, and 5 years by telephone or door respectively. The treatment of the patients was followed up to observe the situation of the patient's medication, the occurrence and time of the event of cerebrovascular disease. The end event was a new event of cerebrovascular disease or the death of the patient for other reasons. Results: during the study, 147 patients were collected in accordance with the standard of the group. Among them, 1 cases died of heart disease and 1 cases died of CO poisoning. 1 cases of unknown cause died and 12 patients were lost in the telephone. The remaining 132 cases were analyzed statistically. The average age was 22~78 years old, the average age was 58.63 + 11.52 years old, the male 95 cases (71.97%), and the female 37 cases (28.03%). The clinical manifestations were 97 cases (73.48%) of the internal carotid artery system symptoms, which showed single or unilateral limb weakness accompanied by speech indifference. In 27 cases, there were 37 cases of single or partial limb weakness, 12 cases of simple speech, 21 cases of abnormal limb sensation (with or without limb weakness), 35 cases of vertebral basilar artery system symptoms, including 26 cases of vertigo, 11 cases, 2 sense of consciousness, 1 cases of fall attack, and 20 cases of cerebral infarction within 5 years of internal carotid system TIA patients, occupied 20.. 62%, 1 cases of cerebral infarction died within 5 years of the vertebral basilar artery system, accounting for 2.86%. The difference was statistically significant (x 2=6.065, P0.05) for 2 days, 7 days, January, March, 1, 3, 4, 4, cerebral infarction, CI. Cases (12.12%), 17 cases (12.88%), 19 cases (14.39%), 21 cases (15.91%), 24 cases (18.18%), 30 cases (22.73%), 24 cases, March, year, year, year, year, year Drug compliance rate is 90.1%, 85.8%, 80.5%, 72.4%, 65.3%, 60.1%, 55.7%, and the compliance rate of antihypertensive drugs is 91.8%, 88.3%, 81.6%, 74.2%, 67.7%, 60.2%, 57.8%, and statins compliance rates gradually decrease with time. The adherence of statins was the worst. Oral antiplatelet aggregation drugs, antihypertensive drugs, compliance with hypoglycemic drugs were associated with cerebral infarction (P0.05), the higher the compliance of the drugs, the lower the incidence of cerebral infarction, the single factor analysis of the risk factors of poor prognosis of.TIA showed that age is more than 60 years old, there are family history of cerebrovascular disease, hypertension, sugar The history of urinary disease, the stenosis rate of carotid artery is more than 50%, different carotid system TIA is a significant risk factor (P0.05) for patients with TIA cerebral infarction within 5 years. Multiple factor Logistic regression analysis is introduced to control the influence of confounding factors, and it is concluded that hypertension, diabetes, cervical vascular stenosis, and the family history of cerebrovascular disease affect TIA The independent risk factors of bad prognosis. Conclusion: 1 age of age and more than 60 years old, there are family history of cerebrovascular disease, hypertension, diabetes history, cervical stenosis rate more than 50%, different carotid artery system TIA is a significant risk factor for cerebral infarction within 5 years of TIA patients, including hypertension, diabetes, neck stenosis rate more than 50%, cerebral blood The family history of tube disease was an independent risk factor; the total infarct rate increased gradually within 5 years after 2 TIA, and increased rapidly in the first 1 months, and the risk of stroke was higher in the first 1 months. The recurrence rate of TIA in the 5 year of 3 TIA increased with the prolongation of time; the rate of medication in 4 TIA patients gradually decreased with time and was taken with statins. The rate was the lowest, and the difference among the groups was significant. The oral antiplatelet aggregation drug, the antihypertensive drug, the compliance of the antihypertensive drugs and the occurrence of cerebral infarction were related to the occurrence of cerebral infarction (P0.05), the higher the compliance, the lower the incidence of cerebral infarction.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.31

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