缺血性脑卒中不同TOAST分型的临床特征、影响因素及预后分析

Clinical characteristics,influencing factors and prognosis analysis of different TOAST classification of ischemic stroke

目的分析不同TOAST分型缺血性脑卒中(ischemic stroke,IS)患者的临床特征、影响因素及预后。方法选取浙江省医疗健康集团衢州医院2019年7月至2021年6月收治的缺血性脑梗死患者500例为研究对象,按照分类标准分为心源性栓塞型(cardioembolism,CE)、大动脉粥样硬化型(large artery atherosclerosis,LAA)、小动脉闭塞型(small-artery occlusion lacunar,SAO)、其他原因引发的缺血性卒中(strike of other determined etiology,SOE),原因不明的缺血性卒中型(stroke of other undetermined etiology,SUE);分析年龄、性别、体质量指数(body mass index,BMI)、病灶位置、病灶范围、基础合并症、不良嗜好、血清炎症因子、脂质代谢相关指标、内皮祖细胞(endothelial progenitor cells,EPCs)、胱抑素-C、同型半胱氨酸(homocysteine,Hcy)在不同TOAST分型IS患者中的差异;随访不同TOAST分型患者在出院6个月至1年的美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及Barthel指数,分析不同TOAST分型患者的预后。结果性别、年龄、病灶位置、病灶范围、是否合并心脏病、是否合并不良嗜好、白细胞介素-6(interleukin-6,IL-6)、氧化型低密度脂蛋白(oxidized low-density lipoprotein,ox-LDL)、人血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、EPCs比例、Hcy水平在不同TOAST分型IS患者中存在差异(P<0.05);EPCs、ox-LDL、Hcy、年龄、合并心脏病是影响IS患者TOAST分型的因素(P<0.05);SUE型IS患者的预后较其他类型IS患者差(P<0.05)。结论不同TOAST分型IS患者的临床特征、影响因素及预后均不同,应在治疗、预防上针对不同TOAST分型IS患者予以相应方案处理。

Objective To analyze the clinical characteristics,influencing factors and prognosis of patients with ischemic stroke(IS)with different TOAST types.Methods A total of 500 patients with ischemic cerebral infarction admitted between July 2019 and June 2021 were selected in the study subjects.According to the classification criteria are divided into CE,LAA,SAO,SOE,SUE type;Differences in age,sex,body mass index(BMI),lesion location,lesion range,basal comorbidities,adverse taste,serum inflammatory factors,lipid metabolism-related indicators,endothelial progenitor cells(EPCs),cystatin-C,and homocysteine in patients with different TOAST type IS were analyzed.NIHSS score and Barthel index of patients with different TOAST classification from 6 months to 1 year after discharge from T and analyzed the prognosis of patients with different TOAST classification.Results Sex,age,lesion location,lesion range,combined heart disease,adverse addiction,IL-6 level,ox-LDL level,Lp-PLA2 level,EPCs proportion,Hcy levels were different in different TOAST type IS patients(P<0.05);EPCs,ox-LDL,Hcy,age,combined heart disease were factors affecting TOAST classification(P<0.05);SUE IS patients had worse prognosis than other types of IS patients(P<0.05).Conclusion The clinical characteristics,influencing factors and prognosis of different TOAST subtype patients with IS should be treated in the treatment and prevention.