采用TOAST分型对高龄缺血性脑卒中患者的单中心资料分析

Analysis of ischemic stroke in the elderly from single center based on TOAST

目的探讨高龄（≥80岁）缺血性脑卒中TOAST分型亚组患者的临床特征、影像学、血管学以及实验室检查结果等方面的差异。方法回顾分析神经科连续住院的91例高龄急性缺血性脑卒中患者的病历和影像学资料，根据TOAST分型进行分组，对各TOAST分型亚组患者的危险因素、临床表现、并发症、短期预后、影像学表现、脑血管病变以及实验室检查结果等情况进行分析对比。结果大动脉粥样硬化（34／91）是高龄缺血性脑卒中的最常见病因，罪犯血管多位于颅内（25／34）。大动脉粥样硬化组颅内（28／34）和颅外（12／34）脑动脉闭塞性病变患者比例均高于其他各组。心脏源性栓塞组患者血脂水平偏低，短期预后不良（7／15）患者比例高于大动脉粥样硬化组和小动脉闭塞组，严重脑水肿（4／15）患者比例高于其他各组，后循环梗死（1／15）和脑白质病变（3／15）患者比例低于小动脉闭塞组。小动脉闭塞组出现并发症（4／20）患者较少，无短期预后不良。结论高龄缺血性脑卒中各TOAST分型亚组患者的临床特征、影像学表现、脑血管病变以及实验室检查结果等方面均存在不同程度的差异，上述差异的临床意义有待进一步探索。

Objective To evaluate the differences of clinical features, neuroimaging, angiography and laboratory findings between different stroke subtypes according to TOAST criteria in elderly patients. Methods 91 patients （aged ≥ 80 years） with acute ischemic stroke were retrospectively reviewed in Departement of Neurology from April 2009 to August 2010. Subtypes of ischemic stroke were analyzed according to the classification of TOAST. Risk factors, clinical manifestations, complications, prognosis, neuroimaging, cerebrovascular lesions, and laboratory findings of different TOAST subtypes were compared. Results Large-artery atherosclerosis （LAA） （34/91） was the most common cause of acute ischemic stroke in elderly patients, and most criminal lesions （25/34） located at the intracranial arteries. In the LAA group, patients with intracranial （25/34） or extracranial （12/34） occlusive diseases were more than those in other groups. Patients with cardioembolism （CE） had lower lipid levels. In the CE group, patients with poor shortterm prognosis （7/15） were more than in the LAA or small-artery occlu＇sion （SAO） group, and patients with severe cerebral edema （4/15） were more than those in other groups. In patients of the SAO group, complications occurred infrequently （4/20）, and none had poor short-term prognosis. Conclusions There were some differences among different TOAST subtypes in clinical features, neuroimaging, cerebrovascular diseases, and laboratory findings. The clinical significance of our findings needs to be explored further.