TOAST分型与脑梗死急性期神经功能和预后的关系

The relationship of TOAST classification with acute neurological impairment and prognosis in cerebral infarction

目的研究TOAST分型与脑梗死急性期神经功能和预后之间的关系。方法根据TOAST分型标准对200例急性脑梗死患者进行分型,采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能评价;比较TOAST不同分型患者随访6个月时的病死率、病死率和(或)病残率及复发率。结果200例患者中大动脉粥样硬化型(LAA型)45例(22.50%)、小动脉闭塞型(SAO型)57例(28.50%)、心源性栓塞型(CE型)41例(20.50%)、其他明确病因型(SOE型)4例(2.00%)以及不明病因型(SUE型)53例(26.50%)。CE型患者脑梗死急性期神经功能缺损程度最为严重[NIHSS评分(21.23±7.82)分],SAO型患者最轻[NIHSS评分(7.24±6.78)分],差异具有统计学意义(均P<0.05);CE型患者随访6个月时病死率为19.51%(8/14),病死率和(或)病残率为46.34%(19/41)、复发率为26.83%(11/41),与SAO型[病死率(1.75%,1/57)、病死率和(或)病残率(5.26%,3/57)、复发率(1.75%,1/57)]比较,差异具有统计学意义(均P<0.05)。结论 TOAST分型可以作为脑梗死急性期神经功能缺损程度和预后的预测指标。

Objective To study the relationship of Trial of Org 10 172 in Acute Stroke Treatment （TOAST） classification with acute neurological impairment and prognosis in cerebral infarction. Methods Data were collected from 200 consecutive acute cerebral infarction inpatients in Taizhou Affiliated Hospital, Nanjing University of Traditional Chinese Medicine from January 2005 to October 2007. All patients were classified by TOAST classification criteria. National Institute of Health Stroke Scale （NIHSS） was used to evaluate acute neurological impairment at admission. The 6-month fatality rate, 6-month fatality and （or） disability rate and 6-month stroke recurrence rate of patients with different subtypes in TOAST classification were compared. Results In 200 cerebral infarction patients, there were 45 cases （22.50%） with large artery atherosclerosis （LAA）, 57 cases （28.50%） with small artery occlusion （SAO）, 41 cases （20.50%） with cardiogenic embolism （CE）, 4 cases （2.00%） with stroke of other determined etiology （SOE）, and 53 cases （26.50%） With stroke of undetermined etiology （SUE）. The neurological impairment in patients with CE was most severe [NIHSS score （21.23 ± 7.82）], while in patients with SAO was very mild [NIHSS score （7.24 ± 6.78）]. The differences were all significant （P 〈 0.05, for all）. The 6-month fatality rate [19.51% （8/41）], 6-month fatality and （or） disability rate [46.34% （19/41）] and 6-month stroke recurrence rate [26.83% （1 t/41）] in patients with CE were higher than those in patients with SAO [1.75% （1/57）, 5.26% （3/57）, 1.75% （1/57）, respectively]. The differences were significant （P 〈 0.05, for all）. Conclusion TOAST classification can be a useful predictive index for acute neurological impairment degree and prognosis in cerebral infarction.