本文選題：中老年　切入點：短暫性腦缺血　出處：《鄭州大學》2014年碩士論文

【摘要】：背景與目的 短暫性腦缺血發(fā)作（Transient IschemicAttack TIA)是指由于腦或視網膜局灶性缺血所致的、不伴急性梗死的短暫性神經功能障礙。臨床癥狀一般持續(xù)10-20min,多在1h內緩解，最長不超過24h，不遺留任何神經功能缺損癥狀，CT或MRI檢查無任何責任病灶。 中老年人為TIA的高發(fā)人群，如果這類人群發(fā)生TIA的危險因素不能得到有效的預防和控制，極有可能進展為腦卒中，影響患者的生活質量。因此，分析中老年TIA的危險因素，同時探討ABCD3評分法應用于預測TIA后早期進展為腦卒中風險評估中的臨床價值是本文的主題。目的是降低TIA進展為腦卒中的發(fā)生率，以減少腦卒中的致殘率，為臨床上對中老年TIA的診療提供依據。 方法: 選取2011年2月至2014年1月期間在鄭大二附院和鄭大四附院住院治療的138例短暫性腦缺血發(fā)作患者作為觀察對象，所有患者的年齡在均在45-80歲之間。將所選取的138例患者根據ABCD3評分表進行評分，并分為低危、中危、高危三組，記錄所有患者7d內腦梗死的發(fā)生率。對影響患者TIA發(fā)作的各種危險因素進行分析，應用ABCD3評分法對所有患者7d內腦梗死的發(fā)生率及影響患者早期進展為腦梗死的相關危險因素進行分析，并應用統(tǒng)計學方法進行比較。 統(tǒng)計學方法：用SPSS17.0統(tǒng)計學軟件對上述數(shù)據進行處理，P0.05表示差異具有統(tǒng)計學意義。 結果 1.低、中、高危組男性患者所占比例分別為76.1%（30/46）、64.81%(35/54)、60.5%(23/38)，年齡≥60歲的患者中，低危組所占比例為10.9%(5/46)，中危組所占比例為75.9%(41/54)，高危組所占比例為63.2%(24/38)； 2.應用Logistic回歸分析各個危險因素對患者的影響大小依次為，高血壓病、高脂血癥、吸煙史，糖尿病、高血壓合并糖尿病、高血壓合并冠心病、房顫、酗酒史、TIA史； 3.頸動脈狹窄程度、血清同型半胱氨酸水平高低、C-反應蛋白水平高低與TIA的危險分層呈正相關（P0.05)； 4.低危、中危、高危組患者比較頸動脈內膜-中層增厚、軟斑、混合斑塊，具有統(tǒng)計學差異（P0.05),而硬斑三組比較無差異（P0.05）； 5.低、中、高危組TIA后7d內腦梗死的發(fā)生率進行比較，結果表明，中危組及高危組與低危組比較有差異（P0.05)，高危組與中危組比較有差異（P0.05)，具有有統(tǒng)計學意義； 6.ABCD3評分為≤3分的患者7d內腦梗死的發(fā)生率為2.17%（1/46)，ABCD3評分4-5分的患者7d內腦梗死的發(fā)生率為14.81%(8/54)，ABCD3評分6-9分的患者7d內腦梗死的發(fā)生率為27.78%(10/36)，通過Spearman相關分析得出，ABCD3評分值與7d內腦梗死的發(fā)生率呈正相關, P0.05,具有統(tǒng)計學意義； 7.不同危險因素對患者TIA后早期發(fā)生腦梗死的Logistic回歸分析結果為，糖尿病、雙重TIA史、TIA癥狀持續(xù)時間≥60min,TIA癥狀發(fā)作頻率≥3次/d，頸動脈中重度狹窄（≥50%）的OR值均1，與TIA后早期發(fā)生腦梗死具有相關性。 結論 1．男性、年齡≥60歲、動脈粥樣硬化、高血壓病、高脂血癥、吸煙史、糖尿病是中老年TIA主要的危險因素； 2．頸動脈狹窄程度、血清同型半胱氨酸水平、C-反應蛋白水平與中老年TIA的病情嚴重程度呈正相關； 3.ABCD3分值越高，，患者TIA后早期腦梗死的發(fā)生率越高；ABCD3評分對TIA后早期發(fā)生腦卒中的風險評估有較高的臨床價值； 4.癥狀持續(xù)時間≥60min、癥狀發(fā)作頻率≥3次/d、頸動脈狹窄≥50%、糖尿病、雙重TIA史是TIA后早期發(fā)生腦梗死的重要且獨立的危險因素。
[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.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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