急性非心源性缺血性脑卒中的病因分型与Essen卒中风险评分  

Aetiological Subtypes and ESRS (Essen Stroke Risk Score) in Acute Non-cardiac Ischemic Stroke

作　　者：吴征瑜[1] 朱志栋[2] 董漪[3] 丁宏岩[3] 韩翔[3] 曹文杰[3] 方堃[3] 程忻[3] 董强[3] 

机构地区：[1]复旦大学附属华山医院老年病科 [2]复旦大学附属华山医院心内科 [3]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华脑血管病杂志（电子版）》2013年第1期1-6,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：目的 Essen卒中风险评估(ESRS)体系可准确评估非心源性缺血性脑卒中(IS)复发的风险。而TOAST(Trial of Org 10172 in acute stroke treatment)分型则是目前应用最广泛的病因分型。本研究着眼于传统与改良的TOAST分型与ESRS的关系,从而间接了解非心源性IS的病因分型与复发风险的关系。方法①对连续纳入的非心源性IS患者行ESRS评估,将其分为低风险组(ESRS<3分)和高风险组(ESRS≥3分);②改良TOAST分型:动脉粥样硬化血栓形成(AT),小动脉病变(SAD),其他原因所致的缺血性脑卒中(SOD)及不明原因的缺血性脑卒中(SUD)。比较不同ESRS分值组之间TOAST分型的构成。结果纳入的316例非心源性IS患者中低风险组93例(29.4%),高风险组223例(70.6%),动脉粥样硬化性脑梗死患(以下简称AT)161例(50.9%),SAD68例(21.5%),SOD22例(7%),SUD65(20.6%)。不同ESRS分值组中不同病因分型的构成存在一定差异(P<0.0001)。低风险组中AT较少(18/93vs161/316,P<0.0001),SOD较多(18/93vs22/316,P=0.003),而高风险组中SOD相对少(4/223vs22/316,P=0.012)。高风险组中大动脉粥样硬化的比例并无明显高于低风险组的趋势(P>0.05),小血管病变的比例也不明显低于低风险组(P>0.05)。结论本研究提示①ESRS分值愈大则出现罕见病因IS的概率可能愈小,而尚不可认为出现动脉粥样硬化性IS的几率就愈大;②ESRS评分系统所包含的危险因素对于大小血管病变的影响可能是等同。Background and Purpose Essen Stroke Risk Score （ESRS） could be used to measure the recurrent risks of acute non-cardiac ischemic stroke. We tried to explore the relationships between aetiological subtypes according to modified TOAST （Trial of Org 10172 in Acute Stroke Treatment） system and ESRS in these patients. Methods We divided consecutive patients with acute non-cardiac ischemic stroke into groups of high risk and low risk, according to if their ESRS was higher than 3 points. We compared the proportion of each TOAST subtype in groups of different ESRS level. Results We had 316 eligible patients in total, 29.4% of which were brought into low risk group and the rest into high risk group. There were 161 patients with atherothrombosis （AT） according to modified TOAST system. There were 68 patients （21.5%） with small artery disease （SAD）, 22 （7%） with stroke of other determined etiology （SOD） and 65 （20.6%） with stroke of undetermined etiologies （SUD）. The proportion of each TAOST subtype in groups of different ESRS levels had a significant difference statistically in all patients （P 〈 0.0001）. AT was less than other subtypes （18 / 93 vs 161 / 316, P 〈 0.0001） and SOD was more than others （18 / 93 vs 22 / 316, P=0.003） in goup of low risk. In group of high risk, SOD was less than others （ 4 / 223 vs 22 / 316, P=0.012 ） , while the proportion of AT and SAD was not different from other subtypes （P〉0.05）. Conclusions Our study indicated that if ESRS of patients with acute non-cardiac ischemic stroke is higher, stroke of other determined etiology may occur less often. But it could not be concluded that patients with higher ESRS level would get more chance to have stroke of atherothrombosis. Risk factors, included in ESRS system, may have an equal influence on large-artery atherosclerosis and small artery disease.

关 键 词：缺血性脑卒中 病因分型 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]