急性脑梗死改良TOAST分型与踝臂指数、颈动脉彩超及相关危险因素分析

Analysis of the Modified TOAST Classification with ABI,Carotid Ultrasonography and Correlated Risk Factors in Acute Cerebral Infarction

目的观察急性脑梗死改良脑卒中试验(M-TOAST)病因分型的构成,分析常见危险因素及踝臂指数(ABI)异常、颈动脉彩超异常在脑梗死中分布的差异。方法采用回顾性研究方法,收集2010年10月—2011年5月入院的急性脑梗死150例,根据M-TOAST标准进行病因分型,分析脑梗死常见危险因素及ABI异常、颈动脉超声异常与TOAST亚型的相关性。结果本组M-TOAST病因各亚型分布为动脉粥样硬化性血栓形成(AT)101例(67.3%),小血管病变(SAD)14例(9.3%),心源性栓塞型(CE)23例(15.3%),不明原因卒中(SOD)9例(6.0%),其他原因卒中(SUD)3例(2.0%)。卒中危险因素各组吸烟史以及高血压的比例均较高,但组间分布差异无统计学意义(P>0.05);不同类型脑梗死患者糖尿病、脂代谢紊乱、ABI异常及颈动脉彩超异常总体差异有统计学意义(P<0.05),组间比较AT型合并血脂紊乱比例高于SAD型及CE型,差异有统计学意义(P=0.03,0.03),后两者间比较差异无统计学意义(P=0.8);颈动脉彩超异常率AT型明显高于SAD型及CE型,差异有统计学意义(P<0.01),SAD型与CE型比较差异无统计学意义(P=0.8);CE型合并心脏病比例显著高于AT型及SAD型,差异有统计学意义(P<0.01);SAD型合并糖尿病比例显著高于AT型及CE型,差异有统计学意义(P=0.04,0.01);CE型ABI指数异常显著高于AT型及SAD型,差异有统计学意义(P=0.03)。结论 M-TOAST分型中AT型为最多见的病因,吸烟、高血压、脂代谢紊乱、颈动脉彩超异常与AT密切相关,糖尿病与SAD密切相关。

Objective To observe the composition of the modified trial of Org 10172 in acute stroke treatment （M-TOAST） classification in acute cerebral infarction and to analyze the distribution differences between common risk factors, unwonted anklebrachial index （ABI） and carotid ultrasonography for cerebral infarction. Methods Retrospective analysis of clinical data of 150 patients with acute cerebral infarction admitted during October 2010 and May 2011 were conducted according to etiology classification by the M-TOAST standard, and the relative analysis between common risk factors, unwonted ABI, carotid ultrasound and TOAST subtypes was also made. Results The distribution of isehemic stroke subtypes according to M-TOAST criteria was 101 patients （67.3%） with atherosclerotie thrombosis （AT）, 14 patients （9.3%） with small artery occlusion disease （SAD）, 23 patients （ 15.3% ） with eardiogenic embolism （CE）, 9 patients （6%） with stroke of other undetermined etiology disease （SOD） and 3 patients （2%） with stroke of other undemonstrated etiology disease （SUD）. The proportion of smoking and hypertension in risk factors of stroke were higher in all groups, but there was no statistical significance （P 〉 0. 05）. The differences in diabetes mellitus, lipid disorders, ABI abnormity and carotid arteries hyperacoustie ahnormity of patients with different types of cerebral infarction were statistically significant, the proportion of AT combined with lipid metabolism disorders was higher than that of SAD and CE group （P = 0. 03, 0.03）, and there was no statistical significance between the two groups （P = 0. 8）. The unwonted proportion of carotid ultrasonography in AT group was higher than that of SAD and CE group （P 〈 0. 01 ）, and there was no statistical significance between the two groups （P = 0. 8）. The proportion of CE combined with heart disease was significantly higher than that of AT and SAD group （ P 〈 0.01 ）. The proportion of SAD combined with diabetes was significantly higher than that of AT and CE groups （P = 0. 04,0. 01 ）. The unwonted index of ABI in CE group was significantly higher than that of AT and SAD groups （P = 0. 03）. Conclusion The AT type is the most common type in the M-TOAST classification. It is likely be correlated to smoking, hypertension, lipid disorders, carotid uhrasonography abnormalities and AT just as diabetes is to the SAD.