摘要目的 探讨缺血性脑卒中患者类肝素药物治疗急性缺血性脑卒中试验(TOAST)病因分型各亚型的构成、危险因素及与复发的关系.方法 采用前瞻性队列研究方法,对2006年10月1日至2007年9月30日本院首发急性缺血性脑率中患者441例的临床资料,按照TOAST标准进行病因分型,随访1年,记录终点事件.结果 TOAST分型各亚型构成为不明病因型(SUE)42.3%、小动脉闭塞型(SAO)30.9%、大动脉粥样硬化型(LAA)17.3%、心源性栓塞型(CE)9.3%、其他明确病因型(SOE)0.2%;各亚型分布在性别、年龄上差异有统计学意义;缺血性脑卒中各亚型1年复发率分别为CE 33.3%、SUE 14.6%、LAA 13.7%、SAO 6.9%;各亚型在吸烟史、高血压、糖尿病、心脏病、总胆同醇、低密度脂蛋白、纤维蛋白原、血糖等方面差异有统计学意义.结论 TOAST分型各亚型问的复发率及危险因素不尽相同,可以为缺血性脑卒中二级预防提供参考依据.

abstractsObjective To analyse subtyping of iscbemic stroke by the criteria of Trial of Org 10 172 in Acute Stroke Treatment (TOAST), its distribution, and relationship between TOAST subtypes, its risk factors and recurrence. Methods Clinical data of 441 patients of ischemic stroke were collected prospectively during October 1, 2006 to September 30, 2007. All the patients were classified by TOAST criteria into five major subtypes and followed-up for one year since its first episode. Dates of its recurrence and death due to recurrence were recorded. Results All the 441 patients with ischemic stroke could be subtyped etiologically according to TOAST criteria as follows: etiology undetermined in 42.3 percent, small-vessel occlusion in 30.9 percent, large-artery atherosclerosis in 17.3 percent, cardioembolism in 9.3 percent, and others in 0.2 percent, without statistically significant difference in its gender and age distributions. Recurrence rate of iscbemic stroke in one year since its first episode for varied subtypes was 33.3 percent for cardioembolism, 14. 6 percent for etiology undetermined, 13.7 percent for large-artery atherosclerosis and 6.9 percent for small-vessel occlusion, respectively. There was no significant difference in risk factors for varied subtypes of iscbemic stroke, including history of smoking, hypertension, diabetes, cardiac disease, and serum levels of total cholesterol, low-density lipoprotein cholesterol, fihrinogen and glucose. Conclusions Varied subtypes of iscbemic stroke had different risk factors and recurrence rate by TOAST criteria, which can be used as an etiologic classification for its secondary prevention.