摘要目的连续收集了本院1959年10月至1977年12月的72例首次短暂性脑缺血发作(transient ischemic attack，TIA)患者，并于1982年、1988年、1993年、1998年分别进行了四次连续随访，其中随访时间最长者达35年。同时观察了首次TIA后的复发情况，TIA患者完全性卒中与心肌梗死的发生情况，及其病死率和死亡原因，各年限的生存率及其95％可信区间，TIA患者神经血管外科的手术指征范围。方法对72例TIA患者进行了最长达35年的随访，采用队列研究，寿命表法等医学流行病学研究方法对上述各观察项目进行分析。结果随访结果显示，总的TIA复发率为27.9％，完全性卒中的发生率65.7％，心肌梗死的发生率8.4％，病死率72.7％；主要死亡原因为完全性卒中，占所有死亡患者的59.6％。其中非老龄患者的首位死亡原因为脑出血，老龄患者的首位死亡原因为脑梗死。致死性心肌梗死患者2例，占死亡患者的2.8％。满29年的生存率为27.3％，其95％可信区间为16.8-37.8％。本研究随访结果显示，有神经血管外科手术指征的患者19人，占所有患者的26.6％。结论本组患者首次TIA后约有近1/3患者出现TIA复发，完全性卒中的发生率较心肌梗死的发生率明显升高。主要死亡原因为完全性卒中而非心肌梗死。估计用神经血管外科手术来预防TIA患者发生完全性卒中的作用有限。

abstractsObjective To observe the long-term follow-up of 72 patients with transient ischemic attack (TIA) and evaluate the clinical significance of neurovascular surgical indication. Methods Seventy-two patients with TIA collected from years 1959 to 1977 were followed up by means of face-to-face communication with the patients themselves or their families till year 1998. According to the principle of life table, the recurrence of TIA after the first attack, occurrence of complete stroke and myocardial infarction, fatality rate, causes of death and survival rate every year, and the 95% confidence interval were calculated and analyzed.Results Till 1998, the recurrent rate of TIA in 72 patients was 27.9%, the occurrence rate of complete stroke 65.7%, and that of myocardial infarction 8.4%. The fatality rate was 72.7%. Among the deaths, 2 (3.8%) patients died of myocardial infarction. It was shown from the study that the main cause of death was complete stroke, accounting for 59.6% of all deaths, with the main cause in non-elderly patients being cerebral hemorrhage, and that in the elderly patients being cerebral infarction. The 20-year survival rate was 39.9% and its 95% confidence interval was (28.4%, 51.4%). Nineteen cases were indicated for neurovascular surgical operation, accounting for 26.6% of the 72 patients. Conclusions In the long-term follow-up study, about one third of the patients had the recurrent TIA. The occurrence rate of complete stroke was markedly higher than that of myocardial infarction. Presumably, the effect of neurovascular surgical operation on the prevention of complete stroke in patients with TIA is limited.