| Objective1．To analyze and compare the differences of anterior and posterior circulationtransient ischemic attack (TIA) in the risk factors and short-term prognosis (within7days).2．To evaluate and compare the value of ABCD3-I score in predicting theshort-term ischemic stroke of anterior and posterior circulation TIA.MethodPatients treated by the First Affiliated Hospital of Zhengzhou University, withsymptoms of TIA within48hours were prospectively registered from November2012to February2014. According to the inclusion criteria,193patients were enrolled.The patients were divided into anterior circulation TIA group and posteriorcirculation TIA group by clinical symptoms and head MRA/CTA/DSA. Related riskfactors were collected in detail and the differences were compared through singlefactors analysis and multiple logistic regression analysis. The basic treatment such asplatelet aggregation inhibitor, improving circulation, statins medicine and so on weregiven, meanwhile risk factors were prevented. Short-term prognosis (including ischemic stroke, TIA recurrence or TIA recurrence+ischemic stroke) of patients withanterior circulation TIA or posterior circulation TIA were analyzed and compared.Then according to the criteria of ABCD3-I score, patients with anterior circulationTIA group or posterior circulation TIA group were respectively divided into low riskgroup (the score≤3) and moderate-high risk group (the score≥4), the value ofABCD3-I score in predicting the short-term ischemic stroke of the anterior circulationTIA or posterior circulation TIA were evaluated and compared.ResultsIn the comparison of risk factors between anterior circulation with posteriorcirculation TIA, singles factors analysis showed that hypertension is the mostcommon risk factor of anterior circulation and posterior circulation TIA patients, andthe hypertension rate was63.9%and65.1%respectively, whose difference betweenthem had no statistical significance (P≥0.05). And for age, gender, hyperlilidemia,hyperhomocysteinemia, smoking history, drinking history, history of stroke, historyof anemia, artery stenosis, duration of symptoms, and the number of TIA≥2, therewere no statistical significance in both anterior circulation and posterior circulationTIA patients (P≥0.05). But the rate of diabetes, coronary heat disease, atrialfibrillation, history of TIA, plasma-fibrinogen and other factors had significantdifference between posterior circulation TIA and anterior circulation TIA (P<0.05);and the rate of atrial fibrillation and history of TIA in anterior circulation TIA weresignificantly higher than that in posterior circulation TIA, the rate of diabetes,coronary heat disease, plasma-fibrinogen and other factors in posterior circulationTIA significantly higher than that in anterior circulation TIA. Multiple logisticregression analysis showed that the incidence of atrial fibrillation (OR=1.816,95%CI1.171-3.461) tended to patients with anterior circulation TIA, and diabetes(OR=0.421,95%CI0.326-0.516) and coronary heat disease (OR=0.614,95%CI0.495-0.733) tended to patients with posterior circulation TIA; and afteradjustment for others, history of TIA, plasma-fibrinogen and other factors had notsignificant difference. In the comparison of short-term prognosis between anterior circulation withposterior circulation TIA, ABCD3-I score in anterior circulation TIA was4.12±1.33,in posterior circulation2.77±1.03, the score of anterior circulation TIA significantlyhigher than posterior circulation (P<0.05). In anterior circulation TIA, the rate ofischemic stroke of short-term prognosis was11.1%, TIA recurrence16.7%, TIArecurrence+ischemic stroke5.5%; In posterior circulation, ischemic stroke was6.3%,TIA recurrence25.4%, TIA recurrence+ischemic stroke4.8%; the differences ofshort-term prognosis in all were no statistically significant (P≥0.05).About the predictive value of short-term by ABCD3-I score for anteriorcirculation TIA, the rate of ischemic stroke in low risk group of anterior circulationTIA was1.9%, TIA recurrence5.8%, TIA recurrence+ischemic stroke0.0%; inmoderate-high risk group of anterior circulation TIA, ischemic stroke was19.4%,TIA recurrence14.9%, TIA recurrence+ischemic stroke6.0%; the rate difference ofischemic stroke and TIA recurrence+ischemic stroke between the two risk groupswere statistically significant (P<0.05), but the rate difference of TIA recurrence wasnot statistically significant (P≥0.05).About the predictive value of short-term by ABCD3-I score for posteriorcirculation TIA, ischemic stroke in low risk group was2.3%, TIA recurrence25.0%,TIA recurrence+ischemic stroke2.3%; in moderate-high risk group, ischemic strokewas16.7%, TIA recurrence16.7%, TIA recurrence+ischemic stroke10.0%; the ratedifference of ischemic stroke between the two risk groups was statistically significant(P<0.05), but the rate difference of TIA recurrence and TIA recurrence+ischemicstroke were not statistically significant (P≥0.05).Conclusions1. Hypertension is the most common risk factor of anterior circulation andposterior circulation TIA patients. Blood pressure should be controlled for patientswith TIA and hypertension.2. Atrial fibrillation has more serious effect on patients with anterior circulationTIA than patients with posterior circulation TIA, so the diagnosis and treatment of atrial fibrillation should be attached importance to for patients with anteriorcirculation TIA. Diabetes and coronary heat disease have more serious effect onpatients with posterior circulation TIA than patients with anterior circulation TIA, sothe control of diabetes and screening of coronary heat disease should be be attachedimportance to for patients with posterior circulation TIA.3. The ABCD3-I score of anterior circulation TIA patients is significantly higherthan posterior circulation TIA patients, but short-term prognosis (ischemic stroke,TIA recurrence or TIA recurrence+ischemic stroke) of both circulations has nodifference.4. The ABCD3-I score have a certain predictive value for short-term ischemicstroke of anterior circulation and posterior circulation TIA patients, and the value ishigher for anterior circulation. |
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