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轻型卒中TOAST病因学分型特点及其与90天功能预后的关系:前瞻性队列研究
Classification and Ninety day Outcome of Mild Ischemic Stroke Subtypes According to TOAST Criteria: A Prospective Cohort Study
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DOI:
作者:
吴燕平
WU Yanping
作者单位:
东南大学附属中大医院
Department of Geriatric Wards, Zhongda Hospital affiliated to Southeast University
关键词:
轻型卒中;小卒中;TOAST分型;预后
mild stoke; minor stroke; TOAST subtype; outcome
摘要:
目的:明确轻型卒中TOAST病因学分型的构成,分析不同亚型与预后的关系。方法:前瞻性入组从2012年5月至2013年7月入住东南大学附属中大医院神经内科的轻型卒中患者,所有患者入院后均完善头颅影像学评估,并行TOAST病因学分型。于发病90天时随访,90天mRS评分≥3为预后不良。分析TOAST各亚型与预后的关系。结果:共有288名轻型卒中患者入组,TOAST各亚型构成如下:小动脉病变型39.2%,大动脉粥样硬化型29.9%,心源性栓塞型8.0%,不确定原因型22.6%,其它病因型0.3%。90天时各亚型不良预后率为:小动脉病变型13.3%,大动脉粥样硬化型52.3%,心源性栓塞型17.4%,不确定原因型23.1%(P=0.000)。经多因素校正后,大动脉粥样硬化型不良预后的风险是小动脉病变型的7.1倍(95%CI[3.4,14.9], P=0.000)。结论:轻型卒中TOAST病因分型中小动脉病变型所占比例最大,预后最好;而大动脉粥样硬化型仍占相当一部分,且预后较差。
Objective: To determine the classification of TOAST subtypes and 90 day outcome of different TOAST subtypes among mild ischemic stroke. Methods: Mild ischemic stroke patients admitted in the Department of Neurology of Zhongda hospital afflicted to Southeast University from June 2012 to July 2013 were prospectively enrolled. Cerebral image examinations were performed for each subject. Stroke pathophysiology was assigned using TOAST criteria. Modified Rankin Scale (mRS) scores≥3 at 90 days was defined as unfavorable outcome. Comparison of 90 day disability rates of different TOAST subtypes was made. Results: Eventually 288 mild ischemic stroke patients were enrolled. The proportions of ischemic stroke subtypes according to TOAST criteria were as follows: small-artery occlusion 39.2%, large-artery atherosclerosis 29.9% , cardioembolism 8.0%, stroke of undetermined etiology 22.6%, acute stroke of other determined etiology 0.3%. 90 day disability rates of different TOAST subtypes were: small-artery occlusion 13.3%, large-artery atherosclerosis 52.3% , cardioembolism 17.4%, stroke of undetermined etiology 23.1% (P=0.000). After adjusted for confounding factors, disability risk for mild stroke patients of large-artery atherosclerosis was significantly higher compared to that of small-artery occlusion(OR 7.1, P=0.000).
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