大动脉粥样硬化型与心源性栓塞型老年大血管闭塞脑卒中患者临床预后的比较

Clinical outcomes of large-artery atherosclerosis type versus cardioembolism type in elderly patients with macrovascular occlusive stroke

目的探讨大动脉粥样硬化型(LAA)与心源性栓塞型(CE)老年大血管闭塞脑卒中患者临床特点及其预后的差异。方法收集2015年1月至2016年12月收治的老年大血管闭塞脑卒中患者238例,根据TOAST分型分为LAA组和CE组,各119例,比较两组患者血浆氨基末端B型利钠肽前体(NT-proBNP)及血清学指标[B型利钠肽(BNP)、C反应蛋白(CRP)、空腹血糖、D-二聚体(D-Dimer)、低密度脂蛋白胆固醇(LDL-C)、前白蛋白]、脑卒中病情、治疗前和治疗后1个月改良RAN-KIN量表(mRS)评分和美国国立卫生研究院卒中量表(NIHSS)评分以及临床预后。结果 LAA组血清BNP、CRP、D-Dimer和血浆NT-proBNP含量低于CE组,而血清LDL-C、前白蛋白含量高于CE组(P均<0. 01)。两组卒中部位比较有统计学差异(P <0. 01),其中CE组在大脑中动脉M1段发生率低于LAA组,大脑前动脉的发生率高于LAA组;两组卒中范围相近(P> 0. 05)。CE组治疗后mRS评分、NIHSS评分显著低于LAA组(P均<0. 01)。CE组预后良好、复发、死亡分别为76例、11例和32例,LAA组为54例、20例和45例,CE组预后优于LAA组(χ2=6. 521,P <0. 05)。结论老年CE型大血管闭塞脑卒中患者的预后好于老年LAA型大血管闭塞脑卒中患者。

Objective To compare the clinical data and prognosis of large-artery atherosclerosis( LAA) type and cardioembolism( CE) type for elderly patients with macrovascular occlusive stroke. Methods A total of 238 elderly patients with macrovascular occlusive stroke from January 2015 to December 2016 were collected. According to TOAST classification,the patients were divided into LAA group and CE group( n = 119 each). The datas were compared between two groups: plasma NT-proBNP and serological indicators( BNP,CRP,fasting blood glucose,D-Dimer,LDL-C,prealbumin),stroke state,as well as the score of modified RAN-KIN scale( mRS) and National Institutes of Health Stroke Scale( NIHSS) which eveluated before treatment and 1 month after treatment. The clinical prognosis of the two groups was also compared. Results The contents of serum BNP,CRP,D-Dimer and plasma NT-proBNP in LAA group were significantly lower than those in CE group,while the contents of serum LDL-C and prealbumin in LAA group were significantly higher than those in CE group( all P < 0. 01). There was significant difference in the location of stroke between two groups( P < 0. 01) in which the incidence of M1 segment of middle cerebral artery in CE group was significantly lower than that in LAA group,while the incidence of anterior cerebral artery in CE group was significantly higher than that in LAA group,but the range of stroke was similar in two groups( P > 0. 05). The mRS score and NIHSS score after treatment in CE group were significantly lower than those in LAA group( all P < 0. 01). Numbers of good prognosis,recurrence and death were 76 cases,11 cases and 32 cases,respectively in CE group,and 54 cases,20 cases and 45 cases in LAA group,respectively,so the prognosis of patients in CE group was significantly better than that in LAA group( χ^2= 6. 521,P <0. 05). Conclusion The prognosis of CE type is better compared with LAA type in elderly patients with macrovascular occlusive stroke.