Objective To investigate the influence of frequentness between transient ischemic attacks and a subsequent cerebral infarction.Methods 558 patients who were the first hospitalization because of the cerebral infarction from January 2010 to June 2012 in Central Hospital of Jiading District in Shanghai City were chosen, all the patients were divided into TIA group (n = 120) and non-TIA group (n = 438) according to whether they had ipsilateral TIA in advance.TIA group was divided into 1 time group, 2-3 times group and > 3 times group according to the frequentness of the TIA.Degree of neurologic impairment were evaluated by the NIHSS scores when the patients were admitted to hospital, the capability of daily living were evaluated by the ADL scores when 3 weeks after the course of disease, the degree of neurologic impairment and the prognosis were compared between the two groups.Logistic regression analysis was used to examine the correlation among the subsequent cerebral infarction and the frequentness of the TIA with other influencing factors.Results The TIA group in mild degree of neurologic impairment and Ⅰ level prognosis [72.5% (87/120), 73.3% (88/120)] were higher than those of non-TIA group [61.9% (271/438), 61.6% (270/438)], the TIA group in moderate degree of neurologic impairment [13.3% (16/120)] and Ⅱ level prognosis [26.7% (32/120)] were lower than those of non-TIA group [23.5% (103/438), 38.4% (168/438)], the differences were all statistically significant (all P < 0.05).The percentage of 2-3 times group in mild degree of neurologic impairment and Ⅰ level prognosis [90.6% (29/32), 91.2% (31/34)] were higher than those of non-TIA group [61.9% (271/438), 61.6% (270/438)], 1 time group [33.3% (2/6), 40.0% (2/5)] and > 3 times group [33.3% (2/6), 67.9% (55/81)], the percentage of 2-3 times group in moderate, severe degree of neurologic impairment and Ⅱ level prognosis [6.3% (2/32), 3.1% (1/32), 8.8% (3/34)] were lower than those of non-TIA group [23.5% (103/438), 14.6% (64/438), 38.4% (168/438)], 1 time group [33.3% (2/6), 33.3% (2/6), 60.6% (3/5)] and > 3 times group [13.4% (11/82), 18.3% (15/82), 32.1% (26/81)], the differences were all statistically significant (all P < 0.05).The frequentness of the TIA, family history, atrial fibrillation and smoking histories were the correlation factors with the degree of neurologic impairment, 2-3 times of frequentness of the TIA was the protective factors (OR < 1.000); the frequentness of the TIA, family history, atrial fibrillation and drinking histories were the correlation factors with the degree of neurologic impairment, 2-3 times of frequentness of the TIA was the protective factors (OR < 1.000).Conclusion Certain frequency and duration TIA before cerebral infarction may have ischemic tolerance effects on brains thereby diminish the degree of neurologic impairment of a subsequent severe cerebral infarction and ameliorate the prognosis of cerebral infarction.%目的 探讨短暂性脑缺血发作(TIA)的发作频度对后继脑梗死的影响.方法 选择上海市嘉定区中心医院2010年1月～2012年6月首次治疗的脑梗死患者558例,按照脑梗死前是否预先发生同侧的TIA分为无TIA组和TIA组,其中TIA组120例,无TIA组438例;TIA组根据发作频度分为1次组、2～3次组和> 3次组3个亚组.采用美国国立卫生研究院脑卒中量表(NIH stroke scale,NIHSS)和日常生活活动能力(activities of daily living,ADL)评分标准,于入院时进行神经功能缺损程度评分,并于病程3周时对各组进行ADL评分,比较各组间神经功能缺损程度、预后.采用Logistic回归分析,检验TIA不同发作频度及其他影响因素与后继脑梗死的相关性.结果 有TIA发作组在神经功能轻度缺损及Ⅰ级预后中所占比例[72.5%(87/120)、73.3%(88/120)]高于无TIA组[61.9%(271/438)、61.6%(270/438)],在中度神经功能缺损[13.3%(16/120)]及Ⅱ级预后[26.7%(32/120)]中所占比例低于无TIA组[23.5%(103/438)、38.4%(168/438)],差异均有统计学意义(P < 0.05).TIA发作2～3次组在神经功能轻度缺损及Ⅰ级预后中所占比例[90.6%(29/32)、96.9%(31/32)]高于无TIA组[61.9%(271/438)、61.6%(270/438)]、1次组[33.3%(2/6)、33.3%(2/6)]及> 3次组[33.3%(2/6)、67.1%(55/82)],在中度及重度神经功能缺损及Ⅱ级预后所占比例[6.3%(2/32)、3.1%(1/32)、3.1%(1/32)]低于无TIA组[23.5%(103/438)、14.6(64/438)、38.4%(168/438)]、1次组[33.3%(2/6)、33.3%(2/6)、66.7%(4/6)]及> 3次组[13.4%(11/82)、18.3%(15/82)、32.9%(27/82)],差异均有统计学意义(均P < 0.05).与神经功能缺损情况有关的因素为TIA发作频度、家族史、房颤史、吸烟史(均P < 0.05),其中,TIA发作2～3次为保护性因素(OR < 1.000);与预后情况有关的因素为TIA发作频度家族史、房颤史、饮酒史(均P < 0.05),其中,TIA发作2～3次为保护性因素(OR < 1.000).
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