【摘要】 目的观察516例缺血性小卒中患者的SSS-TOAST分型情况,并分析颅内梗死灶的特点。方法缺血性小卒中患者516例,进行SSS-TOAST分型,观察颅内梗死灶情况。收集患者年龄、Essen卒中风险分层量表(ESRS)评分、90 d改良Rankin量表(mRS)评分、头颅核磁共振成像(MRI)+磁共振血管成像(MRA)+弥散加权成像(DWI)、颈部血管检查等资料,并在不同SSS-TOAST分型间进行比较。结果 516例缺血性小卒中患者SSSTOAST分型为大动脉粥样硬化型174例(33.72%)、心源性脑栓塞型39例(7.56%)、小动脉闭塞型229例(44.38%)、其他原因11例(2.13%)、原因不明63例(12.21%),主要类型为大动脉粥样硬化型和小动脉闭塞型,其中大动脉粥样硬化型患者大动脉狭窄、90 d mRS评分预后不良发生率高于小动脉闭塞型(P均<0.05)。357例(69.19%)颅内梗死灶为孤立性病灶,其中231例(64.71%)病灶在皮层下、深部白质、基底节等常见位置;159例(30.81%)为多发病灶。282例(54.65%)患者颅内梗死灶直径(或之和)<20 mm,234例(45.35%)直径(或之和)≥20 mm。本组缺血性小卒中患者颅内梗死灶多为孤立性病灶,多数病灶大小<20 mm,孤立性病灶多位于常见位置(P均<0.05)。结论缺血性小卒中患者SSS-TOAST分型多为大动脉粥样硬化型和小动脉闭塞型,前者合并大动脉狭窄和预后不良比例更高;缺血性小卒中患者颅内梗死灶多为常见位置的孤立性病灶,但部分患者颅内梗死灶直径≥20 mm,多发梗死灶者也占一定比例。更多还原

【Abstract】 Objective To observe the SSS-TOAST classification and to analyze the characteristics of cerebral infarction lesions in 516 patients with ischemic minor stroke. Methods The SSS-TOAST classification and lesions analysis were performed in 516 patients with ischemic minor stroke. The data including age,Essen stroke risk scale( ESRS) score,90 d modified Rankin scale( mRS) score,head magnetic resonance imaging( MRI) + magnetic resonance angiography( MRA) + diffusion-weighted imaging( DWI),and cervical vascular examination,etc. were collected. Then we did comparisons between the different SSS-TOAST sub-types. Results The SSS-TOAST classification showed that: there were 174( 33. 72%) patients with large-artery atherosclerosis subtype,39( 7. 56%) patients with cardioembolism subtype,229( 44. 38%) patients with small-artery occlusion subtype,11( 2. 13%) patients with other determined etiology subtype,and 63( 12. 21%) patients with undetermined cause subtype. The main subtypes were small-artery occlusion and large-artery atherosclerosis. We compared these two subtypes and found that patients with large artery atherosclerosis subtype had more arteriostenosis and bad outcomes at 90 d mRS( all P < 0. 05). Totally 357( 69. 19%) patients had isolated lesions,and the isolated lesions of 231( 64. 71%) cases occurred mainly in subcortical location,deep white matter,and basal ganglia; 159( 30. 81%) patients had multiple lesions. The diameter( or sum) of lesion in 282( 54. 65%) patients was less than 20 mm,and 234( 45. 35%) patients’ lesion diameter( or sum) was ≥20 mm. These cerebral infarction lesions in patients with ischemic minor stroke were mostly isolated,diameter < 20 mm,and the isolated lesions were mostly found in common locations( all P < 0. 05). Conclusions The main SSS-TOAST subtypes are large-artery atherosclerosis and smallartery occlusion in patients with ischemic minor stroke,the ratios of arteriostenosis and bad outcomes mainly occur in patients with large-artery atherosclerosis subtype. These cerebral infarction lesions are mostly isolated and found in common locations. However,some patients have infarction diameter≥20 mm and multiple infarction.更多还原