| Objective: Transient ischemic attack(TIA) is currently a common ischemic cerebrovascular disease, is also a high risk factor and important risk factor for ischemic stroke. It’s important to analysis the etiology and risk factors of TIA, and is also very important to evaluate the prognosis and pay close attention to prevention. The purpose of this study is to explore the etiology and risk factors of TIA, in order to better prevent the occurrence of TIA, based on the analysis of clinical information and prospective follow-up data of 272 cases of TIA. And the other purpose is to provide the basis for improving the prognosis of patients with TIA, based on the analysis of the factors related to the occurrence of adverse prognosis of TIA. At the same time we undertake three kinds of evaluation method-ABCD2, ABCD3, ABCD3-V+(ABCD3+vascular assessment)-for long-term forecast assessment of the risk of stroke after TIA, so as to select more reliability method.Methods: We choose 272 patients of TIA as study objects and make detailed records of their basic information, including age, gender, medical history(hypertension, hyperlipidemia, diabetes, coronary heart disease, atrial fibrillation, etc.), smoking history, drinking history, family history of cerebrovascular disease, clinical features(symptoms of internal carotid artery system or vertebral- basilar artery system, seizure frequency, duration of symptoms, attack times, onset to treatment time), laboratory test results(routine blood test, blood lipids, blood sugar, liver and kidney function, blood homocysteine, hypersensitive c-reactive protein, etc), electrocardiogram results, neck vascular ultrasound examination results, examination results of medical imaging(head CT, head MR). Then we conduct follow-ups through phone calls or outpatient services on the second day, the seventh day, the first month, the third month, the first year, the second year, the third year and the ————————————————————————————————————————————————— fourth year respectively after they are chosen as objects. We observe the patient’s medication, ask them whether there is any occurrence of cerebrovascular disease and the time of the occurrence of event, whether or not they have given up smoking and drinking, and whether they have do some appropriate exercise activities. The end point of this experiment is the emergence of cerebrovascular disease or death due to other diseases.The relationship between the various factors and the occurrence of TIA or the occurrence of cerebral vascular disease after TIA is analyzed, using the chi-square test, P<0.05 is considered to indicate a statistically significant difference. We use multivariate logistic regression analysis to get related independent risk factor associated with poor prognosis of TIA. We analysis the relationship between time and the total incidence of cerebrovascular disease after TIA within 4 years, also according to this method, analysis the relationship between ABCD3-V + test scores and the incidence of stroke after TIA within 4 years. The ROC curve analysis is used to compare the accuracy of the three kinds of evaluation method: ABCD2, ABCD3, ABCD3-V+ in predicting the risk of stroke within 4 years after TIA. At last, we make risk stratification according to the ABCD3-V+ evaluation method in patients with TIA, and compare the differences of cerebrovascular disease rates between the groups. All the above data is statistically analyzed using SPSS13.0 software.Results: Statistical analysis of the 272 patients satisfying requirements during this project as follows: all the patients are at the age of 22-80(average 56.77±11.11), including 187 males(age 22-80, average 55.64±11.48), and 85 females( age 38-77, average 59.31±9.83). Among them, 157 patients are followed up for 4 years(age 22-80), including 113 cases of male(age 22-80), and 44 cases of female(age 38-77).Analysis of etiology and risk factors of TIA shows: among the 272 TIA patients, there are 153 cases of hypertension(56.25%), 90 cases of hyperlipidemia(33.08%), 65 cases of diabetes(23.90%), 104 cases of smokers(38.24%), 57 cases of alcoholics(20.96%), 78 cases with Cerebrovascular disease family history(28.68%), 126 cases with unstable plaque in ————————————————————————————————————————————————— ————————————————————————————————————————————————— carotid artery vascular(46.32%), 28 cases with extracranial carotid artery moderately severe stenosis(10.29%), and 113 cases with intracranial arterial moderately severe stenosis(41.54%). The proportion of smoking, drinking and diabetes in male group is higher than female group, the proportion of hypertension is lower than female group, and there is statistical significance difference comparing the two groups. Young and middle-aged group of smoking, drinking, family history of cerebrovascular disease is higher than the proportion of the elderly group, while the elderly group of hypertension, diabetes is higher than the proportion of the young and middle-aged group, and the difference was statistically significant.There are 157 cases of TIA patients are followed up for 4 years, 50 out of the patients develop into cerebral infarction(31.85%, age 29-78), other 107 patients do not develop into cerebral infarction(68.15%, age 22-80). The total number of cases of cerebral infarction occurred within 2 days, 7 days, 1 month, 3 months, 1 years, 2 years, 3 years, 4 years after TIA is 9 cases(5.73%), 16 cases(10.19%), 25 cases(15.92%), 31 cases(19.74%), 37 cases(23.57%), 43 cases(27.39%), 48 cases(30.57%), 50 cases(31.85%) respectively. By the time calculated monthly, we perform a linear correlation analysis about total incidence of adverse outcome of TIA(%) and time, the correlation coefficient(R) is 0.880, P=0.004, and there is a linear correlation(P<0.05). The linear regression analysis shows that there is a positive correlation relationship between the two(P<0.05), the regression coefficient(B) = 0.452, F = 20.589, P = 0.004. With the extension of time, the total incidence of stroke in patients with TIA shows a linear increase trend.As for clinical manifestation, there are 125 patients with TIA have problems in internal carotid artery system, including 97 cases of paroxysmal monoplegia or hemiplegia, 44 cases of speech disorder, 36 cases of partial body paresthesia, 5 cases of visual field defect or blurred vision, 2 cases of amaurosis fugax; the rest 32 patients have vertebrobasilar artery system problems, including 26 cases of paroxysmal vertigo, 1 cases of fall attack, 4 cases of disturbance of consciousness, 2 cases of balance disorder, and 2 cases of diplopia. The cerebral infarction happened to 45 patients(36.00%) with internal carotid artery system TIA, and 5 patients(15.63%) with vertebrobasilar artery system TIA, the difference between the two incidence rate is statistically significant(χ2 = 4.873, P<0.05).Single factor analysis of risk factors of TIA adverse prognostic shows: between different age and accompanied with or without the family history of cerebrovascular disease, hypertension, diabetes, hyperlipidemia, unstable carotid arterial plaque, intracranial artery moderately severe stenosis, extracranial carotid artery moderately severe stenosis and TIA attack history, the differences of the incidence of cerebral vascular disease after TIA exist, and these differences are statistically significant. Then we introduce the above factors to multivariate Logistic regression analysis to control the influence of the confounding factors. It is concluded that: hypertension, diabetes, hyperlipidemia, unstable carotid arterial plaque, intracranial artery moderately severe stenosis, extracranial carotid artery moderately severe stenosis and TIA attack history are independent risk factors in TIA patients’ development into cerebral infarction within 4years.When predicting stroke risk after TIA within 4 years, the AUCs(95%CI)of ABCD2, ABCD3, ABCD3-V+ are 0.799(0.726-0.872), 0.882(0.825-0.938), 0.923(0.878-0.967). As can be seen, area under the curve of ABCD3-V+ evaluation method is the biggest. The accuracy is higher when we use this evaluation method to evaluate the long-term prognosis of TIA. And taking cut-off point of 6.5, the sum of sensitivity and specificity is the largest.Linear correlation exists between ABVD3-V+scoring and the incidence of cerebrovascular disease events after TIA with 4years: the correlation coefficient is 0.872, P=0.000, there is statistical significance. For linear regression analysis between them: B = 10.219, F = 28.679, P = 0.000, there is statistical significance. It can illustrate that there is a positive correlation between the two, with the score increase, the incidence of cerebral vascular disease events after TIA also showed an increasing trend. According to ABCD3-V+ evaluation method, we make risk stratification for TIA patients. ————————————————————————————————————————————————— There are statistical differences between different groups in the incidence of cerebral vascular disease of the patients. The incidence of high-risk group was obviously higher than that in the low-risk group.Conclusions:1 TIA is a clinical syndrome triggered by a variety of causes, a variety of risk factors. The major risk factors in the TIA patients between different sex, different age stages are different.2 The incidence of cerebral infarction after TIA within 7 days, 90 days, 1 years, 4 years is 10.19%, 19.74%, 23.57%, 31.85% respectively. With the extension of time, the total incidence of stroke in patients with TIA shows a linear increase trend. So both short-term and long-term risk assessment and prevention work need to be taken seriously.3 hypertension, diabetes, hyperlipidemia, unstable carotid arterial plaque, intracranial artery moderately severe stenosis, extracranial carotid artery moderately severe stenosis and TIA attack history are independent risk factors in TIA patients’ development into cerebral infarction within 4years.4 ABCD2, ABCD3 and ABCD3-V+(ABCD3+vascular assessment) evaluation method are all effective to predict risk of long-term ischemic stroke after TIA, while the ABCD3-V+ evaluation method is the most sensitive. The risk stratification According to ABCD3-V+ evaluation method can be used to screen people at high risk of ischemic stroke for a long time after TIA.Key words: TIA, risk factors, cerebral infarction, ABCD3 evaluation... |
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