516例缺血性小卒中患者SSS-TOAST分型结果及颅内梗死灶分析  

SSS-TOAST classification and cerebral infarction lesions in 516 ischemic minor stroke patients

作　　者：游文霞[1] 钟剑萍[1] 欧阳基鹏[1] 黎宏庄[1] 杨少民[1] 胡秋根[1] 

机构地区：[1]南方医科大学顺德医院,佛山市顺德区第一人民医院,广东佛山528300

出　　处：《山东医药》2017年第27期9-13,共5页Shandong Medical Journal

基　　金：佛山市医学类科技攻关项目(2014AB001533)

摘　　要：目的观察516例缺血性小卒中患者的SSS-TOAST分型情况,并分析颅内梗死灶的特点。方法缺血性小卒中患者516例,进行SSS-TOAST分型,观察颅内梗死灶情况。收集患者年龄、Essen卒中风险分层量表(ESRS)评分、90 d改良Rankin量表(mRS)评分、头颅核磁共振成像(MRI)+磁共振血管成像(MRA)+弥散加权成像(DWI)、颈部血管检查等资料,并在不同SSS-TOAST分型间进行比较。结果 516例缺血性小卒中患者SSSTOAST分型为大动脉粥样硬化型174例(33.72%)、心源性脑栓塞型39例(7.56%)、小动脉闭塞型229例(44.38%)、其他原因11例(2.13%)、原因不明63例(12.21%),主要类型为大动脉粥样硬化型和小动脉闭塞型,其中大动脉粥样硬化型患者大动脉狭窄、90 d mRS评分预后不良发生率高于小动脉闭塞型(P均<0.05)。357例(69.19%)颅内梗死灶为孤立性病灶,其中231例(64.71%)病灶在皮层下、深部白质、基底节等常见位置;159例(30.81%)为多发病灶。282例(54.65%)患者颅内梗死灶直径(或之和)<20 mm,234例(45.35%)直径(或之和)≥20 mm。本组缺血性小卒中患者颅内梗死灶多为孤立性病灶,多数病灶大小<20 mm,孤立性病灶多位于常见位置(P均<0.05)。结论缺血性小卒中患者SSS-TOAST分型多为大动脉粥样硬化型和小动脉闭塞型,前者合并大动脉狭窄和预后不良比例更高;缺血性小卒中患者颅内梗死灶多为常见位置的孤立性病灶,但部分患者颅内梗死灶直径≥20 mm,多发梗死灶者也占一定比例。Objective To observe the SSS-TOAST classification and to analyze the characteristics of cerebral infarction lesions in 516 patients with ischemic minor stroke.Methods The SSS-TOAST classification and lesions analysis were performed in 516 patients with ischemic minor stroke.The data including age,Essen stroke risk scale （ESRS） score,90 d modified Rankin scale （mRS） score,head magnetic resonance imaging （MRI） ＋ magnetic resonance angiography （MRA） ＋ diffusion-weighted imaging （DWI）,and cervical vascular examination,etc.were collected.Then we did comparisons between the different SSS-TOAST sub-types.Results The SSS-TOAST classification showed that： there were 174 （33.72%） patients with large-artery atherosclerosis subtype,39 （7.56%） patients with cardioembolism subtype,229 （44.38%） patients with small-artery occlusion subtype,11 （2.13%） patients with other determined etiology subtype,and 63 （12.21%） patients with undetermined cause subtype.The main subtypes were small-artery occlusion and large-artery atherosclerosis.We compared these two subtypes and found that patients with large artery atherosclerosis subtype had more arteriostenosis and bad outcomes at 90 d mRS （all P〈0.05）.Totally 357 （69.19%） patients had isolated lesions,and the isolated lesions of 231 （64.71%） cases occurred mainly in subcortical location,deep white matter,and basal ganglia;159 （30.81%） patients had multiple lesions.The diameter （or sum） of lesion in 282 （54.65%） patients was less than 20 mm,and 234 （45.35%） patients＆#39;＆#39; lesion diameter （or sum） was ≥20 mm.These cerebral infarction lesions in patients with ischemic minor stroke were mostly isolated,diameter〈 20 mm,and the isolated lesions were mostly found in common locations （all P〈0.05）.Conclusions The main SSS-TOAST subtypes are large-artery atherosclerosis and small-artery occlusion in patients with ischemic minor stroke,the ratios of arteriostenosis and bad outcomes mainly occur in patie

关 键 词：脑梗死 缺血性小卒中 大动脉粥样硬化 小动脉闭塞 

分 类 号：R743[医药卫生—神经病学与精神病学]