| Objective:Transient ischemic attack(TIA)is one of the dangerous factors for cerebral infarction as well as an emergency in neurology.In the first 90 days after TIA onset,patients have a high risk of being attacked by ischemic stroke as 9%~17%,especially in the first 2 days.There are many major risk factors contributing to TIA and there have been many evidences regarding risk factors of TIA for ischemic stroke.They are the duration of syndrome,age,hypertension,diabetes,dyslipidemia,significant family history and so on.Besides,studies in our country found that the secondary prevention of patients with TIA is still under standard,and the compliance is poor.Therefore,this study was designed to explore the relationship between risk factors and subsequent ischemic stroke after TIA,to observe the incidence of ischemic stroke and TIA recurrence after TIA and to observe the secondary prevention compliance after TIA,in order to provide basis for clinical treatment and prognosis of TIA.Methods:Chose 147 TIA patients as study objects and made detailed records of their basic information,including age,gender,residence,cultural level,history of smoking,history of drinking,previous medical history of hypertension,coronary heart disease and diabetes,as well as family history of cerebrovascular disease,clinical symptoms,duration,onset frequency,laboratory test results,electrocardiogram results,neck vascular ultrasound examination results,examination results of medical imaging(CT or MRI).Every patient was given a standard treatment as the current guidelines recommended,then at the time of discharging,every patient was given their secondary prevention program respectively as the guidelines recommended.Then conducted follow-ups through outpatient services or phonecalls respectively on the first month,the third month,the first year,the second year,the third year,the forth year and the fifth year after they were chosen as objects,asking them their drug use situation,whether there was any occurrence of cerebral infarction and the time of the occurrence.The end point was a new cerebrovascular event or death for other reasons.Results:A total of 147 patients were enrolled during the study,among whom one patient died from heart disease,one died from CO poisoning,one died from unexplained death,and 12 patients lost follow-up due to telephone changes.Statistical analysis of the remaining 132 patients were as follows: all the patients were at the age of 22-78(average 58.63±11.52)including 95 males(71.97%),and 37 females(28.03%).97 patients(73.48%)acted as internal carotid artery system symptoms,among whom 27 patients acted as single or unilateral limb weakness with anepia,37 patients acted as single or unilateral limb weakness,12 patients acted as simple anepia;35 patients acted as vertebra-basilar artery system symptoms,among whom 26 patients acted as vertigo,11 patients acted as diplopia,2 patients acted as unconsciousness,one patient acted as drop attack.The cerebral infarction happened to 20patients(20.62%)with internal carotid artery system TIA,and 1 patient(2.86%)with vertebral-basilar artery system TIA,the difference between the two incidence rate was statistically significant(?2=6.065,P<0.05).Within 2 days,7 days,1month,3 months,1 years,2 years,3 years,4years,5 years after TIA,the total number of cases of cerebral infarction occurred was 3 cases(2.27%),5 cases(3.79%),11 cases(8.33%),12 cases(9.09%),14 cases(10.61%),16 cases(12.12%),17 cases(12.88%),19 cases(14.39%),21 cases(15.91%),respectively;the total number of cases of recurrence of TIA was 21 cases(15.91%),24 cases(18.18),30 cases(22.73%),39 cases(29.55%),43 cases(32.58%),45 cases(34.09%),46 cases(34.85%),46 cases(34.85%),49 cases(37.12%),respectively.During the follow-ups of 1 month,3 months,1 year,2 years,3 years,4years,5 years,the secondary prevention compliance rates of TIA patients were as follows: the compliance rate of antiplatelet medicine was 90.1%,85.8%,80.5%,72.4%,65.3%,60.1%,55.7%,respectively;the compliance rate of antihypertensive drugs was 91.8%,88.3%,81.6%,74.2%,67.7%,60.2%,57.8%,respectively;the compliance rate of hypoglycemic drugs was 94.2%,90.6%,86.5%,82.3%,79.1%,75.4%,72.2%,respectively;the compliance rate of statins was 83.2%,70.6%,52.4%,46.3%,40.1%,35.2%,28.8%,respectively.The rates of drug compliance decreased gradually with time,and the compliance of statins was the worst(P < 0.05).Taking antiplatelet,antihypertensive,hypoglycemic drugs had influence on the risk of cerebral infarction(P <0.05),the higher the compliance,the lower the incidence of cerebral infarction.Single factor analysis of risk factors of TIA adverse prognosis showed that age?60,having a family history of cerebrovascular disease,having a hypertension,diabetes history,carotid stenosis?50%,different carotid system TIA were statistically significant(P < 0.05).Then we introduced the above factors to multivariate logistic regression analysis to control the influence of the confounding factors.It was showed that having a hypertension,diabetes history,carotid stenosis?50%,having a family history of cerebrovascular disease were independent risk factors for TIA patients' development into cerebral infarction within 5 years.Conclusions:1 Risk factors of age?60,having a family history of cerebrovascular disease,having a hypertension,diabetes history,carotid stenosis?50%,different carotid system TIA are statistically significant for cerebral infarction within 5 years(P < 0.05).Among which having a hypertension,diabetes history,carotid stenosis?50%,having a family history of cerebrovascular disease are independent risk factors.2 After TIA,the total infarct rate gradually increases with time,and increases rapidly in the first 3 months,TIA has a higher risk for stroke.3 The overall recurrence rate of TIA after TIA increases with time.4 After discharging,the rate of drug compliance of TIA patients decreases gradually with time,and the compliance of statins is the worst.Taking antiplatelet,antihypertensive,hypoglycemic drugs has influence on the risk of cerebral infarction(P <0.05),the higher the compliance,the lower the incidence of cerebral infarction. |
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