TIA患者预后与脑动脉粥样硬化狭窄特征的相关性研究

发布时间：2018-12-06 20:52

【摘要】：目的：研究短暂性脑缺血发作（TIA）患者预后与脑供血动脉粥样硬化狭窄的程度、狭窄分布部位及粥样硬化斑块性质的关系。方法：选择2012年4月至2013年7月在山西医科大学第一附属医院住院，确诊为TIA的患者，用CTA评价脑血管的狭窄程度，狭窄分布部位及斑块性质。对患者进行90d随访，根据预后情况分为稳定组、频发组、脑梗死组。采用SPSS19.0中文统计软件，分析预后与血管狭窄特征是否相关。结果： 1.共89例患者入选，失访8例。随访的81例TIA患者中稳定组34例（42.0%），频发组37例（45.7%），脑梗死组10例（12.3%）。 2.稳定组24例存在血管狭窄，狭窄31处；频发组35例存在血管狭窄，狭窄65处；脑梗死组10例均有血管狭窄，狭窄39处。稳定组血管狭窄程度构成比：轻度77.4%（24/31），中度16.1%（5/31），重度3.2%（1/31），闭塞3.2%（1/31）；频发组血管狭窄程度构成比：轻度73.9%（48/65），中度10.8%（7/65），重度4.6%（3/65），闭塞10.8%（7/65）；脑梗死组血管狭窄程度构成比：轻度56.4%（22/39），中度10.3%（4/39），重度15.4%（6/39），闭塞17.9%（7/39）。三组预后中，预后越差重度和闭塞血管构成比越大，轻度血管狭窄构成比越小，进行相关分析结果显示r=0.211，P=0.021，，呈正相关。 3.发现斑块117个，稳定组25例患者血管存在斑块，共35个，频发组29例患者血管存在斑块，共51个，脑梗组均有斑块，共31个。稳定组斑块构成比：钙化斑51.4%（18/35），混合斑34.3%（12/35），软斑14.3%（5/35）；频发组斑块构成比：钙化斑23.5%（12/51），混合斑47.1%（24/51），软斑29.4%（15/51）；脑梗死组斑块构成比：钙化斑12.9%(4/31)，混合斑48.4%(15/31)，软斑38.7%(12/31)。三组预后中预后越差混合斑和软斑构成比越大，钙化斑构成比越小。相关分析显示r=0.364，P=0.001，呈正相关。4.本实验中稳定组前循环血管狭窄以ICA颅外段38.9%（7/18）最多见，后循环以VA颅外段38.5%（5/13）多见；频发组和脑梗死组前循环狭窄均以MCA40.0%（16/40）、42.1%（8/19）多见，后循环以VA颅内段36.0%（9/25）、35.0%（7/20），PCA32.0%(8/25)、35.0%（7/20）多见。结论： 1. TIA预后与血管狭窄程度和斑块性质有关。随着预后严重程度的增加，重度和闭塞血管狭窄比例逐渐增多，轻度血管狭窄所占比例逐渐减少，不稳定斑块（软斑、混合斑）所占比例逐渐增多，稳定斑块所占比例逐渐减少。 2.TIA预后良好者前循环以颅外颈动脉狭窄多见，后循环以颅外椎动脉狭窄多见；TIA预后差者前循环以大脑中动脉狭窄多见，后循环以颅内椎动脉和大脑后动脉狭窄多见。
[Abstract]:Aim: to study the relationship between prognosis of patients with transient ischemic attack (TIA) and the degree of atherosclerotic stenosis, distribution of stenosis and the nature of atherosclerotic plaque. Methods: selected patients who were hospitalized in the first affiliated Hospital of Shanxi Medical University from April 2012 to July 2013 and were diagnosed with TIA. The degree of stenosis, the location of stenosis and the character of plaque were evaluated by CTA. The patients were followed up for 90 days. According to the prognosis, the patients were divided into stable group, frequent group and cerebral infarction group. SPSS19.0 Chinese software was used to analyze the correlation between prognosis and vascular stenosis. Results: 1. A total of 89 patients were selected and 8 cases were lost. There were 34 cases (42.0%) in stable group, 37 cases (45.7%) in frequent incidence group and 10 cases (12.3%) in cerebral infarction group. 2. Vascular stenosis was found in 24 cases in stable group, in 31 places in vascular stenosis, in 35 cases in frequent incidence group (65 places), and in 10 cases in cerebral infarction group (39 places). In the stable group, the proportion of stenosis was mild 77.4% (24 / 31), moderate 16.1% (5 / 31), severe 3.2% (1 / 31), occlusion 3.2% (1 / 31). The proportion of the degree of stenosis was 73.9% (48 / 65), 10.8% (7 / 65), 4.6% (3 / 65) and 10.8% (7 / 65) in the frequent incidence group. The proportion of stenosis in cerebral infarction group was mild 56.4% (22 / 39), moderate 10.3% (4 / 39), severe 15.4% (6 / 39), occlusion 17.9% (7 / 39). In the three groups, the worse the prognosis was and the greater the ratio of occlusion and stenosis was, the smaller the ratio of stenosis was. The results of correlation analysis showed that there was a positive correlation between the severity of prognosis and the ratio of occlusion and stenosis. 3. The results showed that there were 117 plaques in 25 patients in stable group, 35 in stable group, 51 in frequently occurring group and 31 in cerebral infarction group. In the stable group, the plaque composition was 51.4% (18 / 35), 34. 3% (12 / 35), 14. 3% (5 / 35) for calcified plaque, 34. 3% (12 / 35) for mixed plaque and 14. 3% (5 / 35) for soft spot. The ratio of plaque composition in frequent group: calcified plaque 23.5% (12 / 51), mixed plaque 47.1% (24 / 51), soft plaque 29.4% (15 / 51); The plaque composition of cerebral infarction group was as follows: calcified plaque 12.9% (4 / 31), mixed plaque 48.4% (15 / 31), soft plaque 38.7% (12 / 31). In the three groups, the worse the prognosis was, the greater the compositional ratio of mixed plaque and soft spot was, and the smaller the ratio of calcified plaque was. Correlation analysis showed that there was a positive correlation between 0. 364 and 0. 001, with a positive correlation of 4. 4. In the stable group, 38.9% (7 / 18) of the anterior circulation stenosis was found in the extracranial segment of ICA, and 38.5% (5 / 13) of the posterior circulation was found in the extracranial segment of VA. MCA40.0% (16 / 40), 42.1% (8 / 19), 36.0% (9 / 25), 35.0% (7 / 20), PCA32.0% (8 / 25) of the intracranial segment of VA were found in the recurrent and cerebral infarction groups. 35.0% (7 / 20) are more common. Conclusion: 1. The prognosis of TIA is related to the degree of stenosis and the nature of plaque. With the increase of prognosis severity, the proportion of severe and occluded vascular stenosis gradually increased, the proportion of mild vascular stenosis gradually decreased, and the proportion of unstable plaque (soft plaque, mixed plaque) gradually increased. The proportion of stable plaques decreased gradually. In the patients with good prognosis of 2.TIA, the anterior circulation was more common in the extracranial carotid artery stenosis and the posterior circulation in the extracranial vertebral artery stenosis, the anterior circulation in the poor prognosis of TIA was the middle cerebral artery stenosis, and the posterior circulation was the intracranial vertebral artery and the posterior cerebral artery stenosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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