摘要
目的探讨短暂性脑缺血发作（TIA）的发病机制。方法广州医学院荔湾医院神经内科收治的52例符合TIA诊断标准的患者入选试验组。用经颅多普勒超声（TCD）检查颅内血管，彩色多普勒血流显像（CDFI）检查颈动脉血管，TCD-MF软件进行微栓子监测30min，取大脑中动脉（MCA）或大脑后动脉（PCA）作监测血管。收集数据经SPSS11．0版软件包分析处理，计数资料差异显著性检验采用X^2检验，计量资料差异显著性检验采用成组t检验，相关分析用Spearman等级相关分析，多因素分析用Logistic回归分析。以P〈0．05为差异具有统计学意义。结果TIA组13例患者微栓子（加隆）阳性（25％）。Spearman等级相关分析显示MES出现与血管狭窄的严重程度呈正相关（CI=0．49，P〈0．01），Logistic回归分析显示责任血管狭窄是MES阳性的独立危险因素（P〈0．01）。抗凝药物治疗10d后11例患者（84．62％）MES为阴性。1年内TIA组MES阳性患者的脑血管事件再发率显著高于MES阴性患者（P〈0．05）。结论TIA的发生与颅内外动脉血管狭窄后引起的脑血流动力学改变、以及动脉粥样硬化斑块形成并脱落形成血液中流动的栓子有关。MES出现与颅内外血管狭窄程度有显著相关性，狭窄程度越高，MES出现的机率也越大。抗凝药物治疗可有效降低MES。MES阳性的TIA患者脑血管事件再发率明显增高。
Objective To investigate the mechanism of transient ischemic attack （TIA） . Method Fifty-two patients from Neurology Department of Liwan Hospital, Guangzhou Medical College, P. R. China, were collected in this study. The patients met the TIA cretiria. Transcranial Doppler （TCD） was used to examine the intro-cranial arteries, the color Doppler flow imaging （CDFI） was used to detect the carotid arteries. Microembolus signals （MES） were monitored by TCJ）-MF software in middle cerebral artery （MCA） or posterior cerebral artery （PCA） for 30 minutes. The data was expressed as （x ± s）, and were analyzed by using Chi-square test, Logistic analysis, and Student＇s t test with SPSS 11.0. A P value less than 0.05 indicated statistical significance. Results MES were found in 13 patients （25%） in TIA group. The occurrence of MES was positively correlated with the severity of artery stenosis （CI = 0.49, P 〈 0.01, by spearman correlation analysis）. Logistic regression analysis showed the artery stenosis was an independent risk factor of the occurrence of MES （ P 〈 0.01）. MES disappeared in 11 patients at 10 days after treated with anticoagulant agents. During one year＇ s follow-up, the recurrence of ischemic event in the MES positive patients was higher than that in the MES negative patients （ P 〈 0.05）. Conclusion The occurrence of TIA was concerned with the change of hemodynamics followed with intro- and extra-cranial arteries stenoses, and with the free circulating embolus coming from the atherosclerotic plaque in the place of arteries stenoses, as well as. The occurrence of microemboli was significantly correlated with intro- and extra-cranial arteries stenoses, and the severer the artery stenosis is, the higher the occurrence of MES is. The anticoagulant agents can reduce MES. The recurrence of ischmic event was significantly increased in TIA patients with MES.
出处
《中华急诊医学杂志》
CAS
CSCD
2008年第1期33-35,共3页
Chinese Journal of Emergency Medicine
基金
广州市荔湾区科技计划项目（20041206030）
