老年大动脉粥样硬化型与心源性栓塞型大血管闭塞脑卒中患者临床预后的对比研究

摘要

Objective To compare the clinical outcomes in elderly stroke patients with large artery atheroclerosis (LAA) and those with cardiogenic embolism (CE)-induced large vessel occlusion (LVO).Methods One hundred and twenty-two ≥65 years old sroke patients with LVO who underwent CT angiography or MR angiography in our hospital from June 2013 to June 2017 were divided into LAA group (n=62) and CE-induced LVO group (n =60) according to the TOAST Classification.Their NIHSS scores on admission and after discharge,good outcome after 3 months of stroke,recurrence rate and mortality of stroke were recorded and compared.Results No significant difference was found in the recurrence rate and mortality of stroke between the two groups (P＞0.05).The good outcome rate was significantly higher while the NIHSS score at discharge was significantly lower in CE-induced LVO group than in LAA group (33.33％ vs 17.74％,P=0.048;10.50±1.24 vs 11.83±1.53,P=0.001).No significant difference was found in the occlusion sites between the two groups (P＞0.05).Conclusion The recovery of neurological function is poorer in stroke patients with LVO than in those with CE-induced LVO.However,no significant difference can be found in the recurrence rate and mortality of stroke between the two groups.%目的 对比分析大动脉粥样硬化(LAA)型与心源性栓塞(CE)型老年大血管闭塞(LVO)脑卒中患者的临床预后.方法 收集2013年6月～2017年6月我院卒中中心收治的年龄≥65岁的老年LVO脑卒中患者122例,经CT血管造影或磁共振血管造影术证实为LVO,根据TOAST分型分为LAA组62例与CE组60例.比较2组患者入院及出院美国国立卫生研究院卒中量表(NIHHS)评分,3个月良好预后、复发率及死亡率.结果 2组复发率及病死率比较,差异无统计学意义(P＞0.05).与LAA组比较,CE组良好预后率明显升高(33.33％ vs 17.74％,P=0.048),出院NIHSS评分明显降低[(10.50±1.24)分vs (11.83±1.53)分,P=0.001].2组LVO闭塞部位比较,差异并无统计学意义(P＞0.05).结论 与CE型LVO脑卒中患者比较,老年LAA型LVO脑卒中患者神经功能康复较差,但两者复发率及死亡率未见明显差异.