不同TOAST亚型青年型缺血性脑卒中患者临床特征及预后分析  

The clinical features and prognosis in patients with different TOAST subtypes of youth ischemic stroke

作　　者：徐瑾[1] 兰丹梅[1] 贺斌[1] 庄建华[1] 彭华[1] XU Jin;LAN Dan-mei;HE Bin;ZHUANG Jian-hua;PENG Hua(Department of Neurology,Shanghai Changzheng Hospital,Shanghai 200003,China)

机构地区：[1]上海长征医院神经内科

出　　处：《世界临床药物》2019年第10期701-706,共6页World Clinical Drug

摘　　要：目的探讨不同亚型青年型缺血性脑卒中患者临床特征及预后的差异。方法分析我院收治的166例青年型缺血性脑卒中患者临床资料,依据不同的Org10172治疗试验(trial of Org 10172 in acute stroke treatment,TOAST)亚型进行分组,比较不同亚型组间临床特征的异同,分析组间预后差异及其影响因素。对其中的66例患者进行长程随访,分析青年型梗死患者的生存影响因素。结果166例青年型缺血性脑卒中患者平均年龄(38.74±5.30)岁,其中男性126例(75.90%),女性40例(24.10%)。不同TOAST分型中,LAA型及SAO型男性多发;UD型、OD型则女性相对较多。危险因素比较分析结果显示,不同亚型患者在高血压、糖耐量异常、心脏病、高脂血症及吸烟这五个危险因素之间的差异具有统计学意义(P<0.05)。预后分析中,发病1年后的预后情况仅与发病2周时的改良Rankin量表(modified rankin scale,mRS)评分相关(F=52.90,P=0.00),而与不同TOAST分型及发病时的严重程度无关(P>0.05)。生存分析结果提示终点事件发生率与发病2周后的mRS评分之间有关联(P=0.00),而与不同TOAST分型、发病时mRS评分、是否持续二级预防以及各种危险因素均无相关性(P>0.05)。结论青年型缺血性脑卒中患者不同TOAST分型中男女好发性及危险因素分布均不同。青年型缺血性脑卒中预后较好,急性期预后与TOAST分型及发病时严重程度相关性大;远期预后则与急性期恢复情况相关性大;未发现相关性较大的危险因素。Objective To investigate the differences of clinical features and prognosis in young patients with different subtypes of ischemic stroke.Methods The clinical data of 166 young patients with ischemic stroke admitted to our hospital were analyzed.The patients were divided into several groups according to different trial of Org10172 in acute stroke treatment(TOAST)subtypes.The clinical characteristics of different subtypes were compared for prognosis and prognostic factors.The influencing factors of survival of young patients with infarction were analyzed by follow-up of 66 patients.Results The average age of young patients with ischemic stroke was(38.74±5.30)years old with 126 males(75.90%)and 40 females(24.10%).In different TOAST types,LAA and SAO were more common in males,UD and OD were more common in females.The results of comparative analysis of risk factors showed that there were significant statistical differences between groups in five risk factors:hypertension,abnormal glucose tolerant,heart diseases,hyperlipidemia and smoking(P<0.05).In the prognosis analysis,the one year prognosis was correlated to modified Rankin score(mRS)at two week(F=52.90,P=0.00),but not correlated to different TOAST type and severity at onset(P>0.05).Survival analysis suggested that the rate of outcome event was related to the mRS score after two weeks of onset(P=0.00),but not related to different TOAST classification and mRS score at onset,continuous secondary prevention and various risk factors.There were no correlations between risk factors(P>0.05).Conclusion The distribution of risk factors and predisposing factors were different in different toast types of young patients with ischemic stroke.The prognosis of young ischemic stroke was good.The acute phase prognosis is closely related to TOAST classification and severity at the time of onset.The longterm prognosis is highly related to the recovery of the acute phase.No significant risk factors were found.

关 键 词：青年型缺血性脑卒中 TOAST分型 临床特征 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]