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目的观察急性脑梗死改良脑卒中试验(M-TOAST)病因分型的构成,分析常见危险因素及踝臂指数(ABI)异常、颈动脉彩超异常在脑梗死中分布的差异。方法采用回顾性研究方法,收集2010年10月—2011年5月入院的急性脑梗死150例,根据M-TOAST标准进行病因分型,分析脑梗死常见危险因素及ABI异常、颈动脉超声异常与TOAST亚型的相关性。结果本组M-TOAST病因各亚型分布为动脉粥样硬化性血栓形成(AT)101例(67.3%),小血管病变(SAD)14例(9.3%),心源性栓塞型(CE)23例(15.3%),不明原因卒中(SOD)9例(6.0%),其他原因卒中(SUD)3例(2.0%)。卒中危险因素各组吸烟史以及高血压的比例均较高,但组间分布差异无统计学意义(P>0.05);不同类型脑梗死患者糖尿病、脂代谢紊乱、ABI异常及颈动脉彩超异常总体差异有统计学意义(P<0.05),组间比较AT型合并血脂紊乱比例高于SAD型及CE型,差异有统计学意义(P=0.03,0.03),后两者间比较差异无统计学意义(P=0.8);颈动脉彩超异常率AT型明显高于SAD型及CE型,差异有统计学意义(P<0.01),SAD型与CE型比较差异无统计学意义(P=0.8);CE型合并心脏病比例显著高于AT型及SAD型,差异有统计学意义(P<0.01);SAD型合并糖尿病比例显著高于AT型及CE型,差异有统计学意义(P=0.04,0.01);CE型ABI指数异常显著高于AT型及SAD型,差异有统计学意义(P=0.03)。结论 M-TOAST分型中AT型为最多见的病因,吸烟、高血压、脂代谢紊乱、颈动脉彩超异常与AT密切相关,糖尿病与SAD密切相关。
Objective To observe the constitution of the etiology of acute cerebral infarction (AMI) stroke-modified stroke (M-TOAST) and to analyze the common risk factors and the differences of ankle brachial index (ABI) and carotid abnormalities in cerebral infarction. Methods A retrospective study was conducted to collect 150 cases of acute cerebral infarction hospitalized from October 2010 to May 2011. The patients were divided into two groups according to M-TOAST criteria. The common risk factors of ABI, ABI abnormalities, carotid ultrasound abnormalities and TOAST subtypes. Results The distribution of M-TOAST subtypes was 101 cases (67.3%) of atherothrombosis (AT), 14 cases (9.3%) of small vessel disease (SAD) 23 cases (15.3%), 9 cases (6.0%) of unexplained stroke (SOD) and 3 cases (2.0%) of other causes of stroke. Risk factors for stroke in each group smoking history and the proportion of hypertension were higher, but the distribution between groups was not statistically significant (P> 0.05); different types of cerebral infarction patients with diabetes, lipid metabolism, ABI abnormalities and carotid ultrasound (P <0.05). There was a significant difference between the two groups in AT-type combined dyslipidemia and SAD and CE (P = 0.03,0.03), but the difference between the two groups was not statistically significant (P = 0.8). The AT type of carotid ultrasonography was significantly higher than that of SAD and CE (P <0.01), and there was no significant difference between SAD and CE (P = 0.8) ; The proportion of CE complicated with heart disease was significantly higher than that of AT and SAD (P <0.01); the proportion of SAD with diabetes was significantly higher than that of AT and CE (P = 0.04 , 0.01). Abnormal CEI ABI index was significantly higher than that of AT and SAD (P = 0.03). Conclusion The AT type is the most common cause of M-TOAST classification. Smoking, hypertension, dyslipidemia and carotid ultrasonography are closely related to AT. Diabetes is closely related to SAD.