摘要目的：探讨非致残性缺血性脑血管事件（non-disablingischemiccerebrovascularevents, NICE）患者的病因学分型与转归的相关性。方法前瞻性连续纳入发病7 d内住院的NICE患者并随访90 d。根据中国缺血性卒中分型（Chinese Ischemic Stroke Subclassification, CISS ）标准对每例患者进行病因学分型。在发病后90 d时评价卒中复发和功能转归，转归良好定义为改良 Rankin 量表（modified Rankin Scale, mRS）评分0~2分。采用多变量logistic回归分析确定复发和转归不良的独立危险因素。结果共纳入162例NICE患者。根据CISS 标准分型，76例（46.9％）为大动脉粥样硬化（large artery atherosclerosis, LAA），54例（33.3％）为穿支动脉疾病（penetrating artery disease, PAD），15例（9.3％）为心源性卒中（cardiogenic stroke, CS ），11例（6.8％）病因未确定（undetermined etiology, UE），6例（3.7％）其他病因（ other etiology, OE）；90 d内共有30例（18.5％）复发卒中，90 d时42例（25.9％）转归不良。复发组糖尿病（46.7％对20.5％；χ2=8.885，P=0.003）、既往卒中或短暂性脑缺血发作史（46.7％对25.0％；χ2=5.572，P=0.018）以及 CS （20.0％对6.8％；Fisher 精确检验：P=0.036）患者比例显著高于未复发组，而PAD 患者比例（16.7％对37.1％；χ2=4.602，P=0.032）显著低于未复发组。多变量logistic回归分析显示，糖尿病[优势比（ odds ratio, OR）2.137，95％可信区间（confidence interval, CI）1.359~4.187；P=0.004]和 CS （OR 5.236，95％CI 2.326~10.256；P<0.001）是NICE复发卒中的独立危险因素。转归不良组高血压（83.3％对61.7％；χ2=6.635，P=0.010）、糖尿病（40.5％对20.0％；χ2=6.900，P=0.009）、心房颤动（35.7％对14.2％；χ2=9.113，P=0.003）、CS（19.0％对5.8％；Fisher精确检验：P=0.017）患者比例显著高于转归良好组，而PAD患者比例（16.7％对39.2％；χ2=7.088，P=0.008）显著低于转归良好组。多变量logistic回归分析显示，糖尿病（OR 2.257，95％CI 1.209~3.687；P=0.010）、心房颤动（OR 3.137，95％CI 1.359~6.107；P=0.002）和CS（OR 6.123，95％CI 2.026~12.256；P<0.001）是NICE患者转归不良的独立危险因素。结论 CISS病因学分型与NICE患者的复发卒中和转归不良有关，可为NICE患者的复发和临床转归评估提供参考。

abstractsObjectiveToinvestigatethecorrelationbetweentheetiologicsubtypeandoutcomein patients w ith non-disabling ischemic cerebrovascular events (NICE). Methods The consecutive patients w ith NICE admitted to hospital within 7 days after onset were enroled prospectively and folowed for 90 days. Etiologic subtypes w ere classified according to the Chinese Ischemic Stroke Subclassification (CISS). Good outcome w as defined as modified Rankin Scale score 0-2. Multivariate logistic regression analysis w as used to identify the independent risk factors for stroke recurrence and poor outcomes. Results A total of 162 patients with NICE were enroled. According to CISS, 76 (46.9%) were classified into large artery&nbsp;atherosclerosis (LAA), 54 (33.3%) into penetrating artery disease (PAD), 15 (9.3%) into cardiogenic stroke (CS), 11 (6.8%) into undetermined etiology (UE), and 6 (3.7%) into other etiology (OE). A total of 30 patients (18.5%) had recurrent stroke w ithin 90 days and 42 (25.9%) had poor outcomes. The proportions of patients w ith diabetes (46.7%vs.20.5%;χ2 =8.885, P=0.003), previous stroke or transient ischemic attack (46.7%vs.25.0%;χ2 =5.572, P=0.018), CS (20.0%vs.6.8%;Fisher exact test:P=0.036) in the stroke recurrence group w ere significantly higher than those in the non-stroke recurrence group, and the proportion of PAD patients in the stroke recurrence group w as significantly low er than that in the non -stroke recurrence group ( 16.7%vs.37.1%; χ2 =4.602, P=0.032 ). Multivariate logistic regression analysis show ed that diabetes (odds ratio [OR] 2.137, 95%confidence interval [CI] 1.359-4.187;P=0.004) and CS (OR 5.236, 95%CI 2.326-10.256; P<0.001) w ere the independent risk factors for recurrent stroke of NICE. The proportions of patients w ith hypertension ( 83.3%vs.61.7%; χ2 =6.635, P=0.010 ), diabetes (40.5%vs.20.0%;χ2 =6.900, P=0.009), atrial fibrilation (35.7%vs.14.2%;χ2 =9.113, P=0.003) and CS ( 19.0%vs.5.8%; Fisher exact test: P= 0.017 ) in the poor outcome group w ere significantly higher than those in the good outcome group, and the proportion of PAD patients ( 16.7%vs. 39.2%;χ2 =7.088, P=0.008) in the poor outcome group w as significantly low er than that in the good outcome group. Multivariate logistic regression analysis show ed that diabetes ( OR 2.257, 95%CI 1.209-3.687; P=0.010), atrial fibrilation (OR 3.137, 95%CI 1.359-6.107, P=0.002), and CS (OR 6.123, 95%CI 2.026-12.256, P<0.001) w ere the independent risk factors for poor outcomes in patient w ith NICE. Conclusions The etiologic subtype is associated w ith the poor outcomes and recurrent stroke, and can provide reference for recurrence and clinical outcome assessment in patients w ith NICE.