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短暂性脑缺血发作对后继脑梗死具有神经保护作用

贾颖1,江荣才2,王毅2,安硕1   

  1. 1. 天津医科大学总医院神经外科
    2. 天津医科大学总医院
  • 收稿日期:2011-11-21 修回日期:2012-04-03 出版日期:2012-10-15 发布日期:2012-10-15
  • 通讯作者: 贾颖

Transient ischemic attack is neuroprotective for the secondary ischemic cerebral infarction

  • Received:2011-11-21 Revised:2012-04-03 Published:2012-10-15 Online:2012-10-15

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摘要： 摘要 目的： 观察短暂性脑缺血发作（TIA）对后继脑梗死的神经保护作用。方法： 选取在脑梗死发病前1周内有2～3次同侧的TIA发作，发作持续时间5～30分钟的患者30例，设为TIA 组；并随机选取无TIA发作的脑梗死患者30例为对照组。两组患者在入院时采用CSS评分标准进行神经功能缺损程度评估，发病72小时后复查头CT测量脑梗死体积，病程1个月时进行ADL评分评价预后。结果： TIA组患者入院时轻度神经功能缺损为22例（73.3%），中重度神经功能缺损为8例（26.7%），对照组分别为14例（46.7%）和16例（53.3%），两组比较有统计学差异（p<0.05）；TIA组患者的脑梗死体积为（6.81±2.46）cm3，对照组为（10.39±4.53）cm3，两组比较有统计学差异（p<0.05）；TIA组患者的Ⅰ级预后和Ⅱ级预后分别为24例（80.0%）和6例（20.0%），对照组分别为16例（53.3%）和14例（46.7%），两组比较有统计学差异（p<0.05）。结论： 短暂性脑缺血发作可减轻脑梗死的神经功能损害，减少脑梗死的体积并改善预后。 可能与其能诱导人脑产生缺血耐受，对后继脑梗死具有神经保护作用有关。

关键词: 短暂性脑缺血发作, 脑梗死, 缺血耐受, 神经保护, 预后

Abstract: Abstract Objective: To confirm whether transient ischemic attack(TIA) is neuroprotective for secondary ischemic cerebral infarction. Methods: 60 patients suffered from ischemic cerebral infarction were recruited. 30 of them were enrolled in the TIA group, who all experienced 2~3 times TIA in one week before the cerebral infarction attacks and the TIA always persisted for 5～30 minutes. The other 30 without previous confirmed TIA history were recruited into the control group. CSS was applied to evaluate the degree of neurologic impairment when the patients were admitted. Calculation of the infarction volume was performed 72 hours later after admission. The one month prognosis after admission was assayed using ADL. Results: In TIA group, 22 (73.3%) and 8(26.7%) patients showed mild and moderate neurological impairment respectively. In the control group, the percent of the patients suffering from the mild and moderate neurological impairment was 46.7% (14 cases) and 53.3%(16 cases) respectively. When compared to the control group, more patients in the TIA one showed mild neurological impairment and less one suffered from moderate neurological injury (p<0.05). The mean cerebral infarction volume was significant less in the TIA group with (6.81±2.46) cm3 than in the control one with (10.39±4.53)cm3（p<0.05）. One month later, 24 patients (80.0%) in TIA group recovered to ADL grade I, while only 16 patients (53.3%) in the control one had the grade I outcome (p<0.05) . Conclusion: TIA can alleviate ischemic neurologic injury, reduce the infarction volume and then improve the prognosis. The reason might be TIA induces ischemic tolerance effect on brains and lead to neuroprotective effect on the subsequent cerebral infarction.

Key words: Transient ischemic attack, cerebral infarction, ischemic tolerance, neuroprotective effects, prognosis