复发性脑梗死不同TOAST分型的危险因素分析

Analysis on risk factors for different recurrent cerebral infarction subtypes according to the TOAST criteria

目的分析复发性脑梗死患者不同TOAST分型危险因素的差别。方法将2009年4月～2010年4月间在山西医科大学第一医院神经内科住院的复发性脑梗死患者连续入组，收集各住院患者相关的临床资料，记录各项相关辅助检查结果数据，并对其各项研究内容予以赋值。按照TOAST标准将住院患者分为五个亚型，比较各亚型导致复发的相关因素之间的差别。结果复发性脑梗死TOAST各亚型构成比例为：大动脉粥样硬化型（LAA）20．2％，心源性栓塞型（CE）14．4％，小动脉闭塞型（SAA）27．1％，其他明确病因型（SOE）3．2％，不明原因型（SUE）35．1％。高血压、脂代谢异常、纤维蛋白原含量在各亚型间比较差异有统计学意义（P〈0．05），前两者在大动脉粥样硬化型组（LAA）所占比例最高。结论在复发性脑梗死TOAST5个亚型间比较，高血压、脂代谢异常在大动脉粥样硬化型组（LAA）所占比例最高，纤维蛋白原水平LAA组亦高于其他组，提示高血压、脂代谢异常、纤维蛋白原水平在该组的复发中起到更为重要的作用。

Objective To analysis the difference of risk factors for recurrent cerebral infarction subtypes according to the TOAST criteria. Methods Data were collected prospectively from consecutive recurrent ischemic stroke inpatients in the Department of Neurology of the First Hospital of Shanxi Medical University from April 2009 to April 2010. After completing medical records and auxiliary diagnostic studies, all included patients were classified into 5 major ischemic stroke subtypes based on TOAST criteria. The difference of the factors were compared among different subtypes of recurrent cerebral infarction. Results The proportion of ischemic stroke subtype according to TOAST criteria was as follows：large-artery atherosclerosis（LAA）20.2%, cardioembolism（CE）14.4%, small-artery occlusion lacunar （SAA） 27.1%, stroke of other demonstrated etiology（SOE）3.2%, stroke of undetermined etiology （SUE） 35.1%. The proportions of hypertension, lipid metabolism disorder and fibrinogen had statistic differences among the 5 groups（P〈0.05）. The highest proportions of hypertension and lipid metabolism disorder were seen in large-artery atherosclerosis（LAA）patients compared to the others. Conclusions In the comparison among the 5 groups, the highest proportions of hypertension and lipid metabolism disorder are seen in LAA patients. The fibrinogen concentration in LAA group is also higher compared with that in others（P〈0.05）.Hypertension, lipid metabolism disorder and fibrinogen concentration may play more important roles in the recurrence of LAA.