高龄缺血性脑卒中分型及与预后关系的研究

Relationship between different subtypes and long-term prognosis for very old ischemic stroke patients

目的了解高龄脑梗死患者牛津郡社区卒中项目（OCSP）临床分型和急性缺血性脑卒中Org 10172治疗实验（TOAST）病因分型和预后。方法采用前瞻性队列研究,登记2007年1月-2008年5月环湖医院神经内科确诊的1019例脑梗死患者,按照年龄分为≥80岁脑梗死组和〈80岁脑梗死组,按照OCSP标准和TOAST标准分型并进行随访,分析≥80岁脑梗死和〈80岁脑梗死与预后和危险因素之间的的关系。结果≥80岁脑梗死组TACI构成比高于〈80岁脑梗死组,≥80岁脑梗死组预后不良率为57.1%,而〈80岁脑梗死组预后不良率为28.7%,差异有显著意义（P〈0.01）。吸烟、饮酒、房颤、动脉狭窄、久坐的生活方式的发生率在两组组间差异有显著性意义（P〈0.01）。结论≥80岁脑梗死组预后比〈80岁脑梗死组更差。房颤在≥80岁脑梗死组所占比例显著高于〈80岁脑梗死组,是需要关注的一个危险因素。

Objective To analyze the proportion and prognosis of ischemic stroke subtypes in elderly patients aged 80 years or more.Methods Data were collected prospectively from consecutive stroke inpatients in Huanhu Hospital from Janurary,2007 to May,2008 after completing medical records and auxiliary diagnostic studies.Patients were stratified according to age on admission.All the patients were followed up and were classified into different subtypes according to the OCSP and TOAST criteria when they were on admission.The risk factors for ischemic stroke in all patients were assessed.Results Elderly patients showed a significantly lower proportion of arterial stenosis,smoking and alcohol consumption and a higher proportion of atrial fibrillation.There was significant difference in atrial fibrillation between the two groups aged≥80 years and〈80 years.The percentage of worse outcome of this group was 57.1%,higher than the control group（28.7%）.Conclusion The aged≥80 years group had worse outcome.Apart from very old age,factors such as atrial fibrillation should be taken into consideration when planning treatment and rehabilitation after stroke.