缺血性脑卒中TOAST病因分型危险因素及短期预后分析

目的分析缺血性脑卒中各TOAST亚型的危险因素及短期预后。方法连续收集急性缺血性脑卒中患者300例,按照TOAST分型标准进行病因分型。采用美国国立卫生院神经功能评分标准(NIHSS)对所有患者入院当天、3 d、7 d、14 d、出院当天进行神经功能评分。治疗期间筛查并记录各亚型患者的危险因素。对比分析各亚型患者治疗期间神经功能改善情况,并采用logistic回归模型对各TOAST亚型患者的危险因素进行分析。结果TOAST分型情况:心源性脑栓塞(CE)40例;大动脉粥样硬化性卒中(LAA)47例;小动脉卒中(SAA)143例;其他原因引发的缺血性卒中(SOE)5例;原因不明的缺血性卒中(SUE)65例。与大动脉粥样硬化性卒中相关的危险因素为高血压和高血脂(P<0.05);与小动脉卒中(SAA)相关的危险因素仅为高血压(P<0.05)。心源性栓塞患者神经功能缺损最严重,恢复较慢,预后最差;小动脉卒中患者神经功能缺损最轻,恢复最快,预后最好;其他类型卒中介于两者之间。结论 TOAST作为一种病因分型方法可以有效地为缺血性脑卒中的预后估计及危险因素预防提供帮助。     

缺血性脑卒中TOAST病因分型及研究进展

脑血管病发病、致死、致残和复发率均很高，已成为人类死因的第2位。由于缺血性脑卒中的病因复杂，不同病因对预后影响可能不同。因此，对缺血性脑卒中患者进行病因分型，有助于根据不同分型采取不同的治疗和预防措施。目前临床较常用的病因分型方法是TOAST(The Trial of Org10172 in Acute Stroke Treatmere)分型法。该分型是以NINCDS分型系统为依据，     

缺血性脑卒中的分型及与预后的关系

当缺血性脑卒中的诊断确立之后，进一步确定其亚型将有助于治疗病因和评估预后；有利于更具针对性地进行二级预防；同时也有利于对临床试验中的患进行分层，以便为个体化治疗提供详细的依据。因此，临床医师有必要了解目前临床常用的缺血性脑卒中的分型方法，以及TOAST(the Trial of     

缺血性脑卒中TOAST亚型分析

TOAST分型法侧重于缺血性卒中病因学分型，在临床工作中得到广泛应用，近年来对其进行了大量相关研究。     

青年缺血性脑卒中TOAST病因分型临床研究

目的探讨青年人脑梗死Toast分型与危险因素的临床特点。方法回顾性分析87例我院青年缺血性脑卒中患者的临床资料,根据TOAST病因分型标准确定本组患者的卒中亚型,并计算各个缺血性脑卒中危险因素构成比。结果本组患者TOAST亚型构成比为大动脉粥样硬化型脑梗死42.53%(37例),心源性栓塞型6.90%(6例),小动脉病变型34.48%(30例),其他病因明确的5.75%(5例),不明原因10.34%(9例)。该组患者危险因素从高到低分别是高血压、吸烟、高脂血症、饮酒、糖尿病、脑血管病家族史。结论在我国青年人缺血性脑卒中患者动脉粥样硬化型与小动脉病变型脑梗死占较大比例,其中高血压、吸烟、高脂血症与饮酒为青年人缺血性脑卒中主要危险因素。     

青年缺血性脑卒中TOAST分型的临床意义

目的采用TOAST分型法研究青年缺血性脑卒中的特征。方法收集64例15～45岁急性缺血性脑卒中患者,并经头部CT或MRI证实;所有患者均行胸部X线、心电图、血常规、血糖、血脂、凝血功能及血管炎方面的检查,多数患者做了血管方面的检查;脑卒中依据TOAST标准分型。结果青年缺血性脑卒中男性患者所占比例较女性患者明显增高,脑卒中亚型;大动脉粥样硬化性脑卒中占21.9%,小动物闭塞脑卒中占32.8%,心源性脑栓塞占18.8%,其他原因引发的缺血性脑卒中占15.6%,原因不明的缺血性脑卒中占10.9%。15～35岁患者心源性脑栓塞和其他原因引发的缺血性脑卒中占相对高的比例;35岁以上患者大动脉粥样硬化性脑卒中及小动脉闭塞性脑卒中占相对高的比例。吸烟、酗酒的男性患者比例较女性患者显著增高,女性患者高血压病的比例较男性患者增多。结论根据TOAST分型及危险因素的研究结果,对不同年龄层次的青年缺血性脑卒中患者有不同的临床意义。     

缺血性脑卒中NEW-TOAST病因学分型及与预后关系的研究

目的:依据NEW-TOAST及TOAST分型对缺血性脑卒中进行构成比分析,了解NEW-TOAST各亚型与预后的关系.方法:选取2006年1月至2007年12月在暨南大学附属第一医院神经内科住院的缺血性脑卒中患者连续入组.收集所有病例的临床资料,采用NEW-TOAST、TOAST标准进行分型,随访患者1年后的复合终点事件,并做一致性检验.结果:共纳入296例患者,按照NEW-TOAST分型:动脉粥样硬化血栓型(AT)为39.86%;心源性脑栓塞型(CE)为6.42%;小动脉型(SAD)为26.35%;其他原因型(SOD)为1.35%;不明原因型(SUD)为26.01%.TOAST分型中有37例在新分型中转为其他亚型.新分型Kappa=0.81,显示为高度一致.1年随访期内,发生复合终点事件45例,其中AT型为20.56%; CE型为44.44%;SAD型为8.45%;SUD型为12.68%.经卡方检验,CE型的复合终点事件的发生率最高(P<0.05).结论:缺血性脑卒中以NEW-TOAST分型中AT型所占比例最高,该分型的一致性好,可信度高,可以做为缺血性脑卒中研究的依据,值得进一步临床研究.     

TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系研究

目的 研究TOAST分型的急性缺血性脑卒中患者血糖变异性及其和预后的关系。方法 选取本院2014年2月～2015年2月接诊的112例急性缺血性脑卒中患者作为研究对象,据血糖监测将其分为血糖变异组和非血糖变异组,对所有患者的TOAST分型各亚型血糖变异性、TOAST分型各亚型血糖变异性两两比较情况、NIHSS评分以及Barthel指数、患者预后的多因素进行分析。结果 2组患者的年龄、糖尿病史以及NIHSS评分患者例数具有明显差异(P<0.05)。血糖变异组患者的LAA患者例数明显多于非血糖变异组(P<0.05),LAA组血糖变异性与SAO组和CE组比较有明显差异(P<0.05),而SAO组和CE组的血糖变异性没有明显差异(P>0.05)。入院半个月后血糖变异组患者的NIHSS评分以及Barthel指数没有明显差异(P>0.05),而非血糖变异组患者的NIHSS评分以及Barthel指数均有明显的变化,且2组患者在入院半个月后的NIHSS评分以及Barthel指数有明显差异(P<0.05)。年龄、NIHSS评分以及血糖变异等因素与急性缺血性脑卒中患者预后有关。结论 年龄、糖尿病史、LAA患者等均是影响患者血糖变异性的相关因素,且血糖变异性对急性缺血性脑卒中患者的预后具有一定的影响,是其独立的危险因素,即血糖变异性异常的急性缺血性脑卒中患者的恢复较缓慢,预后情况不良。     

急性非心源性缺血性脑卒中的病因分型与Essen卒中风险评分

目的Essen卒中风险评估（ESRS）体系可准确评估非心源性缺血性脑卒中（IS）复发的风险。而TOAST（Trial of Org 10172 in acute stroke treatment）分型则是目前应用最广泛的病因分型。本研究着眼于传统与改良的TOAST分型与ESRS的关系,从而间接了解非心源性IS的病因分型与复发风险的关系。方法①对连续纳入的非心源性IS患者行ESRS评估,将其分为低风险组（ESRS〈3分）和高风险组（ESRS≥3分）;②改良TOAST分型：动脉粥样硬化血栓形成（AT）,小动脉病变（SAD）,其他原因所致的缺血性脑卒中（SOD）及不明原因的缺血性脑卒中（SUD）。比较不同ESRS分值组之间TOAST分型的构成。结果纳入的316例非心源性IS患者中低风险组93例（29．4％）,高风险组223例（70．6％）,动脉粥样硬化性脑梗死患（以下简称AT）161例（50．9％）,SAD68例（21．5％）,SOD22例（7％）,SUD65（20．6％）。不同ESRS分值组中不同病因分型的构成存在一定差异（P〈0．0001）。低风险组中AT较少（18／93VS161／316,P〈0．0001）,SOD较多（18／93 vs 22／316,P=0．003）,而高风险组中SOD相对少（4／225 vs 22／316,P=0．012）。高风险组中大动脉粥样硬化的比例并无明显高于低风险组的趋势（P〉0．05）,小血管病变的比例也不明显低于低风险组（P〉0．05）。结论本研究提示①ESRS分值愈大则出现罕见病因IS的概率可能愈小,而尚不可认为出现动脉粥样硬化性IS的几率就愈大;②ESRS评分系统所包含的危险因素对于大小血管病变的影响可能是等同。     

缺血性脑卒中的病因分型与危险因素

目的探讨缺血性脑卒中病因分型与不同危险因素的关系。方法回顾性分析连续登记的急性缺血性卒中患者,记录其危险因素,并按急性卒中治疗试验（TOAST）标准将缺血性卒中分为5种类型分析相关危险因素对其发生风险的影响。结果在纳入分析的205例患者中,大动脉粥样硬化性卒中（LAA）100例（48．9％）、心源性卒中（CE）17例（8．3％）、小动脉闭塞性卒中（SAO）38例（18．5％）、其他原因所致卒中（SOE）12例（5．8％）、不明原因卒中（SUE）38例（18．5％）。分析显示,高血压与LAA的发生有关（OR=2．40,P=0．0028）;心房颤动对CE发生有显著作用（OR=365．90,P〈0．0001）;饮酒与SAO的发生可能有一定关联（OR=2．73,P=0．036）,而白细胞则在CE患者显著升高（OR=8．00,P=0．0013）。结论不同类型缺血性脑卒中与不同的危险因素有关。该结果对临床个体化预防与治疗有一定提示意义。     

1019例脑梗死OCSP分型及其与预后关系的研究

目的 了解脑梗死患者OCSP 临床分型的构成及不同亚型与预后及复发的关系.方法 采用前瞻性队列研究,登记2007年1月～2008年5月环湖医院神经内科确诊的1019例脑梗死患者,按照OCSP标准分型分为TACI、PACI、POCI和LACI,并进行随访,分析各亚型与预后及复发的关系.结果 OCSP各亚型构成比分别为:TACI占4.3%、PACI占54.2%、POCI占29.4%、LACI占12.1%,分型与预后明显相关,TACI的预后最差,POCI和LACI预后相对较好,PAC1次之.复发与分型有明显相关.结论 OCSP分型作为一种脑梗死临床分型方法,可以为脑梗死的预后判断提供参考依据.     

神经肽Y启动子基因多态性与脑梗死TOAST亚型相关性研究

目的 针对脑梗死多因素致病特点,探讨神经肽Y(NPY)启动子基因多态性与脑梗死TOAST分型各亚型的关系. 方法 采用聚合酶链反应(PCR)和基因测序技术,检测549例脑梗死患者NPY启动子基因-399T/C、-883Tgins/del和-602G/T基因型及等位基因,其中大动脉粥样硬化型(LAA)190例,小动脉闭塞型(SAO)260例,心源性栓塞型(CE)60例,其他明确原因型(ODE)29例,原因不明型(UE)10例,并与423例汉族健康体检者对照.Logistic回归分析去除混杂因素影响,分析NPY启动子基因多态性与脑梗死TOAST分型各亚型的相关性. 结果 SAO亚型-399T/C突变基因型CC和等位基因C频率与对照组比较差异均有统计学意义(P=0.046,P=0.010);LAA亚型和SAO亚型高尿酸、高血压、心脏病和DM病史较对照组明显增高,比较差异有统计学意义(P＜0.05);SAO亚型-883Tgins/del缺失突变基因型DD、等位基因D频率与对照组比较差异无统计学意义(P=0.061,P=0.155);-399T/C、-883Tgins/del、-602G/T多态性与LAA亚型、CE亚型、ODE亚型和UE亚型患者均无相关性. 结论 NPY启动子基因-399T/C多态性可能与脑梗死SAO亚型发病存在相关性,高频率等位基因-399C个体可能是SAO亚型重要危险因素.没发现-399T/C、-883Tgins/del、-602G/T基因多态性与LAA亚型、CE亚型、ODE亚型和UE亚型患者有相关性.高尿酸、高血压、心脏病和糖尿病史是LAA亚型和SAO亚型危险因素.     

TOAST criteria applied in acute ischemic stroke

BACKGROUND: Etiological subclassification of ischemic stroke has become increasingly important, as new therapeutic agents have been introduced. The aim of this study was to assess the inter-rater reliability of the TOAST classification applied in the acute setting, and further to evaluate the criterion validity of the TOAST classification in discriminating between small vessel disease and other etiologies. METHODS: From June to December 2001, 38 patients with acute ischemic stroke were included in the present study. All were classified according to the TOAST criteria by two junior registrars shortly after admission. Later, a consensus classification was made based on a comprehensive investigation programme. RESULTS: The inter-rater reliability between the two junior registrars was very good (kappa 0.88). The overall agreement between initial and consensus classifications was fair (kappa 0.30). The TOAST classification discriminated between small vessel disease and other subgroups in most patients (sensitivity 0.93, specificity 0.83). CONCLUSION: Etiological subclassification of ischemic stroke requires extensive cerebrovascular investigation. Normally, such resources are not available at admission. Nevertheless, the TOAST classification should be used in this setting to help physicians differentiate between small vessel disease and other etiologies of acute stroke, particularly when therapies with possible harmful side effects are considered an option.     

Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes

BACKGROUND: Different topographic patterns in patients who experience an acute ischemic stroke may be related to specific stroke causes. OBJECTIVE: To determine if lesion patterns on early diffusion-weighted imaging (DWI) are associated with stroke subtypes determined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. DESIGN: Cross-sectional study. SETTING: General community hospital.Patients We studied 172 consecutive ischemic stroke patients with a symptomatic lesion on DWI performed within 24 hours of stroke onset. MAIN OUTCOME MEASURES: Lesion patterns on DWI were classified into single lesions (corticosubcortical, cortical, subcortical > or =15 mm, or subcortical <15 mm), scattered lesions in one vascular territory (small scattered lesions or confluent with additional lesions), and multiple lesions in multiple vascular territories (in the unilateral anterior circulation, in the posterior circulation, in bilateral anterior circulations, or in anterior and posterior circulations). RESULTS: We found an overall significant relationship between DWI lesion patterns and TOAST stroke subtypes (P<.001). Corticosubcortical single lesions (P =.01), multiple lesions in anterior and posterior circulations (P =.03), and multiple lesions in multiple cerebral circulations (P =.008) were associated with cardioembolism. Multiple lesions in the unilateral anterior circulation (P =.04) and small scattered lesions in one vascular territory (P =.06) were related to large-artery atherosclerosis. Nearly half (11/23) of the patients with a single subcortical lesion that was 15 mm or larger were classified as having cryptogenic strokes (P =.001), although 9 of these patients had a classic lacunar syndrome without cortical hypoperfusion. CONCLUSIONS: Early DWI lesion patterns are associated with specific stroke causes. Conventional 15-mm criteria for lacunes, however, may underestimate the diagnosis of small-vessel occlusion with DWI.     

Relationship between subtypes of MRI-confirmed acute ischemic stroke based on OCSP and TOAST classifications

BACKGROUND： Two classification systems exist for subtypes of acute cerebral infarction. One was developed for the Trial of Org 10172 in Acute Stroke Treatment （TOAST）, based primarily on etiology. The other is the Oxfordshire Community Stroke Project （OCSP）, based on clinical features.
OBJECTIVE： To evaluate the relationship between OCSP and TOAST classifications in terms of stroke location and etiology in 126 patients with acute ischemic stroke confirmed by transcranial magnetic resonance imaging （MRI）.
DESIGN, TIME AND SETTING： Retrospective case analysis. Transcranial MRI, diffusion weighted imaging, and magnetic resonance angiography were performed in 126 patients with acute stroke during the first 48 hours following admission to the Department of Neurology, Navy General Hospital of Chinese PLA.
PARTICIPANTS： A total of 126 patients with acute stroke, comprised of 71 males and 55 females, admitted to the Navy General Hospital of Chinese PLA between December 2005 and April 2006 were included.
METHODS： Of 126 patients with acute stroke, 13 exhibited total anterior circulation infarcts （TACI）, 51 had partial anterior circulation infarcts （PACI）, 28 suffered posterior circulation infarcts （POCI）, and 34 had lacunar infarcts （LACI） based on OCSP classification. However, according to TOAST classification, 19 cases were a result of large-artery atherosclerosis, 32 by cardioembolism, 36 by small-vessel occlusion, 1 by stroke of other determined etiology, and 38 by stroke of undetermined etiology.
MAIN OUTCOME MEASURES： The corresponding relationship of the subtypes of acute stroke based on OCSP and TOAST.
RESULTS： Of patients with TACI, 8 （61.5%） were caused by cardioembolism. Of patients with PACI, 16 （31.4%） were caused by large-artery atherosclerosis and 17 （33.3%） by cardioembolism. Of patients with POCI, 12 （42.8%） were a result of small-vessel occlusion. Of patients with LACI, 17 （50.0%） were caused by hypertension and arteriolar sclerosi     

Non-convulsive status epilepticus after ischemic stroke: a hospital-based stroke cohort study

To evaluate in the setting of a stroke unit ward the usefulness of a prolonged (>6 h) video-EEG recording (PVEEG) in identifying non-convulsive status epilepticus (NCSE) in patients with an acute ischemic stroke. Predictors of NCSE were also evaluated. Patients with an acute ischemic stroke, referred to our unit, were included in this prospective observational study. A PVEEG recording was implemented after stroke in all patients during the first week: (a) promptly in those exhibiting a clear or suspected epileptic manifestation; (b) at any time during the routine activity in the remaining patients. After the first week, a standard EEG/PVEEG recording was hooked up only in presence of an evident or suspected epileptic manifestation or as control of a previous epileptic episode. NCSE was identified in 32 of the 889 patients (3.6 %) included in the study. It occurred early (within the first week) in 20/32 (62.5 %) patients and late in the remaining 12. Diagnosis was made on the basis of a specific clinical suspect (n = 19, 59.4 %) or without any suspect (n = 13, 40.6 %). In a multivariate analysis, a significant association of NCSE was observed with NIHSS score, infarct size and large atherothrombotic etiology. NCSE is not a rare event after an acute ischemic stroke and a delayed diagnosis could worsen patient prognosis. Since NCSE can be difficult to be diagnosed only on clinical grounds, implementation of a prompt PVEEG should be kept available in a stroke unit whenever a patient develop signs, although subtle, consistent with NCSE.     

急性脑梗死TOAST病因分型与血浆纤维蛋白原的相关研究

目的探讨急性脑梗死患者血浆纤维蛋白原(FIB)水平与脑梗死TOAST各亚型的关系。方法79例急性脑梗死患者按TOAST病因分型方法分类后,检测患者血浆纤维蛋白原浓度,比较病例组与对照组以及各亚型之间的血浆FIB水平。结果除其他原因引起的缺血性卒中(SOE)因例数少未作分析外,与对照组相比,脑梗死组各亚型中的FIB浓度增高均有显著意义;其中,FIB浓度在大动脉粥样硬化亚型(LAA)中的浓度最高,但与心源性亚型(CE)无明显差异,与腔隙性亚型(SAA)相比,两组均有显著意义。结论血浆FIB水平在脑梗死发生、发展过程中起重要作用,其中与LAA、CE型的发生关系更为密切。