缺血性卒中TOAST分型与预后关系的一年随访研究  

One-year Follow-up Study on the Relationship between TOAST Subtypes of Ischemic Stroke and its Prognosis

作　　者：安中平[1] 赵文娟[1] 王景华[2] 

机构地区：[1]天津市环湖医院神经内科,天津300060 [2]天津医科大学总医院神经病学研究所,天津300052

出　　处：《中国慢性病预防与控制》2010年第5期494-496,共3页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：天津市科委科技支撑计划重点项目(07ZCGYSF02800)

摘　　要：目的研究缺血性脑卒中TOAST分型与预后的关系。方法收集自2007年1月—2008年5月在天津市环湖医院卒中单元病房住院治疗的1 019例急性缺血性脑卒中患者,男性630例,女性389例,平均年龄(64.54±11.60)岁。脑卒中依据TOAST标准分型,即大动脉粥样硬化型(LAA)、心源性栓塞型(CE)、小动脉闭塞型(SAO),其他明确病因型(SOE)和不明原因型(SUE)5型。应用NIHSS评分和改良Rankin评分(mRS)了解不同亚型患者入院时和随访1年时的功能状态,并评价不同亚型患者预后,复发率和病死率的差异。结果缺血性脑卒中男性患者发病年龄较女性患者早(P<0.001)。脑卒中亚型:LAA 689例(67.6%),SAO例(20.4%),CE例(7.0%),SUE例(3.8%),SOE例(1.2%),其中LAA亚型所占比例最高。各亚型与预后的关系:CE型患者入院时病情危重,神经功能缺损最严重,NIHSS评分最高(15.82±9.56),SAO亚型入院时病情最轻(4.19±4.30)。1年时CE亚型预后不良发生率(50.70%)、复发率(33.3%)和病死率(36.62%)均高于其他亚型。SAO亚型预后不良发生率(7.96%)、复发率(15.8%)和病死率(2.88%)均为最低。结论 SAO亚型预后佳,可作为独立的因素预测预后。CE亚型复发率和病死率最高,预后最差。Objective To study the relationship between TOAST subtypes of ischemic stroke and prognosis.Methods 1 019 patients（630 males and 389 females） with acute ischemic stroke（IS） aged between 21 to 94 yrs hospitalized in a special neurological hospital in Tianjin were collected during Jan.,2007 to May 2008.All patients were divided into 5 subtypes based on the TOAST clinical classification.The neurological functions of patients at 24 hours and at 1 year after onset were evaluated by NIHSS scale and modified Rankin scale.The incidence of unfavorable prognosis,recurrence and mortality rate in all subtypes were assessed.Results In our study,the incidence of IS in men was significantly higher than that in women,and the average age of female patients was older than that of the male ones.Stroke subtypes included large artery atherosclerosis（67.6%）,small artery occlusive disease（20.4%）,cardioembolism（7.0%）,other vascular disorders（1.2%）,and undetermined cause（3.8%）.Patients with cardioembolism had the most severe neurological impairment in all subtypes and its NIHSS scale was the highest（15.82±9.56）.At the end of 1 year follow-up,patients with small artery occlusive disease were found having a poor prognosis,higher recurrence and mortality rate,compared with those in patients with cardioembolism（7.96% vs 50.70%,15.8% vs 33.3%,2.88% vs 36.62%）.Conclusion The clinical outcomes caused by cardioembolism are the worest.The prognosis of patients with small artery occlusive disease was the best.SAO subtype is regard as the independent predictive factor for patients’prognosis.

关 键 词：缺血性脑卒中 TOAST分型 预后 随访研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]