脑梗死患者TOAST和MRI分型与其短期预后的相关性

Correlation of TOAST and MRI classification with short-term prognosis of patients with cerebral infarction

目的探讨急性脑梗死(ACI)患者TOAST分型、MRI分型与其短期预后的相关性。方法回顾性分析2018年1月~2021年1月本院收治的ACI患者153例临床资料,比较不同TOAST分型、MRI分型各亚型患者的临床基线资料、血清学指标及美国国立卫生研究院量表评分(NIHSS)变化情况;根据出院后3个月的改良Rankin量表(mRS)评分结果将患者分为预后良好组(mRS≤2分,n=89)和预后不良组(mRS>2分,n=64),分析TOAST分型和MRI分型与患者短期预后的相关性。结果153例患者中,TOAST分型为心源性栓塞型(CE)的患者36例,小动脉闭塞型(SAO)42例,大动脉粥样硬化型(LAA)40例,其他原因型(SOE)14例,不明原因型(SUE)21例;MRI分型为大梗死型的患者20例,中梗死型31例,小梗死型43例,腔隙梗死型59例;不同TOAST分型患者入院时NIHSS评分、血清胱抑素C(Cys-C)、同型半胱氨酸(Hcy)和低密度脂蛋白(LDL)水平比较,大梗死型>中梗死型>小梗死型>腔隙梗死型(均P<0.05),NIHSS评分减少率比较,大梗死型<中梗死型<小梗死型<腔隙梗死型(均P<0.05)。预后不良组患者的年龄、入院时NIHSS评分、血清Cys-C、Hcy和LDL水平明显高于预后良好组,NIHSS评分减少率低于预后良好组(均P<0.05),两组患者的TOAST和MRI分型比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、入院时NIHSS评分、NIHSS评分减少率、Cys-C、Hcy、LDL、TOAST分型为CE型、MRI分型为大梗死型是ACI患者短期预后的影响因素(P<0.05)。结论TOAST分型和MRI分型均与ACI患者的短期预后存在相关性,NIHSS评分、Cys-C、Hcy、LDL水平、TOAST分型为CE型、MRI分型为大梗死型是ACI患者短期预后的影响因素。

Objective To explore the correlation of TOAST and MRI classification with short-term prognosis of patients with acute cerebral infarction(ACI).Methods The clinical data of 153 patients with ACI admitted to the hospital were retrospectively analyzed between January 2018 and January 2021.The clinical baseline data,serological indicators and National Institutes of Health Stroke Scale(NIHSS)scores of patients with different TOAST types and different MRI types were compared.According to the modified Rankin Scale(mRS)score at 3 months after discharge,the patients were divided into good prognosis group(mRS≤2,n=89)and poor prognosis group(mRS>2,n=64).The correlation of TOAST classification and MRI classification with short-term prognosis of patients with ACI was analyzed.Results TOAST classification of the 153 patients showed cardiogenic embolism(CE)in 36 cases,small artery occlusion(SAO)in 42 cases,large artery atherosclerosis(LAA)in 40 cases,other vascular disorders(SOE)in 14 cases,and undetermined cause(SUE)in 21 cases.MRI classification showed large infarction in 20 cases,medium infarction in 31 cases,small infarction in 43 cases,and lacunar infarction in 59 cases.The order of NIHSS score at admission,serum cystatin C(Cys-C),homocysteine(Hcy)and low-density lipoprotein(LDL)levels in patients with different TOAST subtypes from high to low was as follows:large infarction>medium infarction>small infarction>lacunar infarction(P<0.05).The order of the reduction rate of NIHSS score from low to high was as follows:large infarction<medium infarction<small infarction<lacunar infarction(P<0.05).Age,NIHSS score at admission,serum Cys-C,Hcy and LDL levels of patients in the poor prognosis group were significantly higher than those in the good prognosis group,and the reduction rate of NIHSS score was lower than that in the good prognosis group(P<0.05).There were significant differences in TOAST and MRI classification between the two groups(P<0.05).Logistic regression analysis showed that age,NIHSS score at admission,reduction rate of NIHSS score,Cys-C,Hcy,LDL,TOAST classification as CE type,MRI classification as large infarction type were influencing factors of short-term prognosis of patients with ACI(P<0.05).Conclusion Both TOAST classification and MRI classification are related to the short-term prognosis of patients with ACI.NIHSS score,Cys-C,Hcy and LDL levels,TOAST classification of CE type,MRI classification of large infarction type are factors influencing the short-term prognosis of patients with ACI.