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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 investigate the relationship between TOAST classification and prognosis in ischemic stroke. Methods A total of 1 019 acute ischemic stroke patients admitted to the Central Hospital of Stroke in Tianjin from January 2007 to May 2008 were enrolled. There were 630 males and 389 females, with an average age of 64.54 ± 11.60. year old. Stroke was classified according to the TOAST criteria, namely, atherosclerosis (LAA), cardioembolic (CE), arteriovenous occlusion (SAO), other definite causes of illness (SOE) and unexplained type. NIHSS score and modified Rankin score (mRS) were used to understand the functional status of patients with different subtypes at admission and at 1 year of follow-up, and to evaluate the differences of prognosis, recurrence rate and mortality between different subtypes. Results The onset age of male patients with ischemic stroke was earlier than that of female patients (P <0.001). Stroke subtypes were LAA 689 (67.6%), SAO (20.4%), CE (7.0%), SUE (3.8%) and SOE (1.2%) with the highest proportion of LAA subtypes. The relationship between subtypes and prognosis: CE patients admitted to hospital in critical condition, the most serious neurological deficit, the highest NIHSS score (15.82 ± 9.56), SAO subtype admitted to hospital the lightest condition (4.19 ± 4.30). At 1 year, the adverse prognosis of CE subtypes (50.70%), relapse rate (33.3%) and case fatality rate (36.62%) were higher than other subtypes. The poor prognosis of SAO subtypes (7.96%), recurrence rate (15.8%) and mortality (2.88%) were the lowest. Conclusions SAO subtypes have good prognosis, which can be used as an independent prognostic factor. The recurrence rate and mortality of CE subtypes were the highest with the worst prognosis.