急性后循环梗死患者TOAST分型特征

TOAST classification of posterior circulation infarction patients

目的通过分析急性后循环梗死的TOAST分型特征,探讨后循环梗死患者的病因及机制。方法选取南京卒中注册系统中首次急性后循环梗死患者共435例,所有患者均行CT、MRI、脑数字减影血管造影术、超声心动图等相关检查,分为近段梗死、中段梗死和远段梗死。各项检查完善后参照TOAST分型标准分为大动脉粥样硬化型(221例)、小动脉闭塞型(83例)、心源性栓塞型(88例)、其他明确病因型(10例)及不明原因型(33例)。结果急性后循环梗死患者大动脉粥样硬化型最常见(50.8%),其次为心源性栓塞(20.2%)、小动脉闭塞型(1 9.1%)。与年龄<45岁患者比较,中老年患者的大动脉粥样硬化型后循环梗死最常见(P<0.05)。在所有患者中,远段梗死最常见(53.7%),其次为中段梗死(30.3%)及近段梗死(23.2%)。近段梗死患者的小动脉闭塞型较少见,与远段梗死、中段梗死比较,差异有统计学意义(P<0.05)。结论大动脉粥样硬化是我国后循环梗死最常见的病因,后循环梗死病因存在年龄、性别、部位差异。明确后循环梗死的病因,对于制定针对性的治疗方案意义重大。

Objective To investigate the cause and mechanism of the acute posterior circulation infarction through TOAST classification. Methods 435 consecutive patients with first-ever posterior circulation infarction were extracted from Nanjing Stroke Registry Program. Some auxiliary examinations, such as computerized tomography, magnetic resonance imaging, digital subtraction an- giography,ultrasound cardiography and so on,were performed in all patients. All patients were divided into proximal segment group,middle segment group and distal segment group. Referring to TOAST classification, the posterior circulation infarction was classified as large-artery atherosclerosis（221 cases）,small-artery occlusion （83 cases）,cardioembolism（88 cases）,other determined etiology（10 cases） and undetermined etiology（33 cases）. Results Referring to TOAST classification,large-artery atherosclerosis was the most common mechanism（50.8%）. Then there were cardioembolism（20.2 % ） and small-artery occlusion（19.1%）. Compared with patients under 45 years old,the prevalence of large-artery atherosclerosis in middle-aged or old patients was higher （P 0.05）. The most common location of infarcts was in the distal segment（53.7% ）, followed by mid- die（30.3%） and proximal segments（23. 2%）. Compared with middle segment group and distal segment group, prevalence of small-artery occlusion in patients with proximal segment infarction was lower （P 〈 0.05）. Conclusions Large-artery atherosclerosis was the most common mechanism of the posterior circulation infarction in China. The posterior circulation infarction mechanisms were different in different ages, sexes and infarct locations.