【作者】 许靖；

【导师】 陈秋惠；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：分析TIA及TIA形式的脑梗死临床特点，探索其临床相关因素。方法：回顾性分析吉林大学白求恩第二临床医院2010年1月至2012年2月期间神经内科收治的83例初步诊断为TIA并在症状首发后24小时内行常规MRI及DWI检查的患者，发病1周内行颈部动脉血管彩超、TCD和（或）头颈部CTA。记录一般危险因素、临床特征、相关检查结果及发病后7天内的临床转归。根据DWI结果分为DWI+组及DWI-组，DWI+组为DWI显示与TIA症状和体征相关的高信号责任病灶组，即为TIA形式的脑梗死组；DWI-组为DWI扫描未见高信号病灶组。确定DWI阳性率。比较DWI+组及DWI-组危险因素、临床特征及相关检查结果的差别。分析2组患者动脉粥样硬化斑块的部位、性质、数量及颅内外血管狭窄的部位、程度。所有数据采用spss13.0进行统计学处理。结果：（1）DWI阳性率为36.1%，DWI+组30例，其中累及颈内动脉系统24例、椎-基底动脉系统6例；DWI-组53例，其中累及颈内动脉系统26例、椎-基底动脉系统27例，2组间差异有统计学意义（χ2=7.65,p=0.006）。（2）DWI+组与DWI-组相比，在年龄、性别、高血压、缺血性心脏病病史、糖尿病、心房纤颤、缺血性脑血管病病史、吸烟史、血脂及纤维蛋白原水平等方面均无统计学差异。（3）DWI+组与DWI-组相比在运动障碍、构音障碍、感觉障碍、中枢性面瘫、偏盲、单眼或双眼一过性视物不清、晕厥、复视、眩晕、共济失调、发作性跌倒、耳鸣、症状持续时间≥30分钟、DWI检查前TIA发作次数等方面均无统计学差异。（4）DWI阳性与动脉粥样硬化相关（P=0.03），与颈部动脉动脉粥样硬化斑块数目相关（P=0.04），与颈部动脉粥样硬化斑块的类型不相关（P=0.23），与颅内及颈部动脉血管中、重度狭窄程度不相关（血管彩超统计结果：P=0.99；头颈部CTA结果：P=0.41），与病变血管分布不相关（血管彩超统计结果：P=0.51，头颈部CTA结果：P=0.40）），与颈部动脉粥样硬化斑块的分布不相关。（5）TIA症状首发后7天内，30.0%DWI+组患者TIA症状反复发作或表现为临床症状持续存在，高于DWI-组（22.6%）。DWI+组中，16.7%TIA反复发作，13.3%表现为临床症状持续存在；DWI-组中，22.6%TIA反复发作，病人进展为脑梗死，两组在临床转归上有统计学差异（P=0.006）。结论：（1）临床表现为TIA的病例大于1/3急性期DWI检查可发现阳性病灶，即已经形成了脑梗死，颈内动脉系统多于椎-基底动脉系统。（2）DWI+组与DWI-组比较在一般危险因素、临床特征等方面未见明显的统计学差异。（3）DWI阳性与动脉粥样硬化相关，动脉粥样硬化斑块数量越多，DWI阳性的可能性越大，与血管狭窄程度、动脉粥样硬化斑块的性质及病变血管分布无关。（4）DWI+对临床症状表现为TIA的病人预后具有提示作用，与是否形成临床症状持续的脑梗死具有相关性，DWI+的病人7天内更易进展。（5）传统TIA的概念不再是区分是否发生缺血性损伤的标准，更准确的标准依赖包括DWI在内的MRI检查，DWI检查对症状表现为TIA的病人必不可少。更多还原

【Abstract】 Objective:The purpose of this study was to analyze clinical featuresbetween transient ischemic attacks and cerebral infarction displaying transientischemic attacks，to explore the relative clinical factors.Methods:A retrospeetive analysis was performed on83patients entered inneurology department of our hospital during2010.1-2012.2who were clinicallydiagnosed as TIA.all patients underwent MRI and DWI scan<24hours aftersymptoms onset. TCD and neck arterial color dopplar ultrasound or(and) CTAwere performed within1week after symptoms onset.A detailed history of TIApatients was investigated record clinical data and results of every assistedexamination.We separate the TIA patienis to two parts：with or without DWIabnormalities,to identify the positive rate of DWI abnormalities.We comparedthe risk factors,clinical symptoms,likely etiology,assisted examinations andprognosis(7days) of the two part TIA patients. Compare the distribution,degreeof intra and extra-cranial artery stenosis,analyze the distribution,type ofatheromatous plaque.Statistical analysis were performed with the spssstatistical package(13.0),Quantitative data was analyzed by independent-sample t-test,chi-square test or rank sum test.The results were regarded assignificance when p＜0.05.Results:(1)30out of83TIA patients (36.1%) revealed focal abno-rmalities on DWI;24out of50cases with carotid system TIA (48.0%) werefound acute ischemic lesions on DWI;6out of33cases with vertebrobasilarsystemTIA18.2%) were found acute ischemic lesions on DWI. There wasdifference between the two groups (χ2=7.65， p=0.006).（2） The risk factors:age,sex,blood pressure,history of ischemic heart disease, diabetesmellitus,atrial fibrillation,history of ischemic cerebrovascular disease,smoke,hyperlip-emia, fibrinogen,do not relate to the positive rate of DWI.(3) Theclinical features:the duration of symptoms,limb weakness, speech impairment,sensory disturbance, facial paralysis, hemianopsia, syncope, iplopia,dizziness,dystaxia, onset fall, tinnitus and the frequency of TIA before examination ofDWI do not relate to the positive rate of DWI.(4)The large arteryatherosclerosis is relate to the positive rate of DWI(p=0.03).The number ofatheromatous plaque in large artery atherosclerosis is relate to the positive rateof DWI(p=0.04).The type of atheromatous plaque is not relate to the positiverate of DWI(p=0.23).The intracranial and cervical angiostegnosis are not relateto the positive rate of DWI(color Doppler sonography:p=0.99,CTA:p=0.41).The distribution of atheromatous plaque in intracranial and cervical large arteryis not relate to the positive rate of DWI.(5) Within7days after TIAoutbreaks,The prognosis of DWI+(30.0%) is higher than DWI-(22.6)，there are5(16.7%) patients display repetitious TIA in DWI+,4(13.3%) patientsdeveloping into persisting clinical symptoms;however, there are12(22.6%)patients display repetitious TIA in DWI-,there is no patients developing intopersisting clinical symptoms,the type of ischemic cerebrovascular diseasewithin7days after TIA outbreaking displays statistical significance(p=0.006).Conclusions:(1) More than l/3patients displaying TIA had DWIabnormalities,it has already formed the cerebral infarction,the internal carotidartery system is more than vertebrobasilar arteries system.(2) There is nostatistical significance in the risk factors,clinical symptoms between DWI+andDWI-.(3) The large artery atherosclerosis is relate to positive of DWI, the moreatheromatous plaque,the more positive frequency of DWI,The type ofatheromatous plaque,the intracranial and cervical angiostegnosis,thedistribution of atheromatous plaque in intracranial and cervical large artery are no relate to DWI+.(4) Imformations from DWI were useful in estimatingprognosis,it relates to the type of ischemic cerebrovascular disease.The patientof DWI+are more likely to develop into persisting clinical symptoms within7days.(5) Traditional definition can not distinguish whether ot not happenhistologic damage,more accurate examination depends on MRI including DWI.There is no relation in the risk factors,clinical symptoms between DWI+andDWI-.The examination of DWI is essential for TIA patients更多还原