Clinical significance of TOAST typing of ischemic stroke in young adults

Jingli Liu; Jinpin Li

摘要：BACKGROUND: Ischemic stroke in young adults brings extremely hurts for their families and society, and the etiological factors and risk factors are different in the world.OBJECTIVE: To analyze and evaluate clinical significance of ischemic stroke in young adults by using TOAST typing.DESIGN: Case analysis.SETTING: Department of Neurology, the First Affiliated Hospital, Guangxi Medical University.PARTICIPANTS: A total of 64 young adults with acute ischemic stroke were selected from the Department of Neurology, the First Affiliated Hospital, Guangxi Medical University from September 2005 to June 2006.There were 44 males and 20 females and their age ranged from 15 to 45 years. All patients met with the diagnostic criteria of the Fourth National Cerebrovarscular Academic Meeting and certainly diagnosed with CT or MRI examination. In addition, all patients provided the confirmed consent.METHODS: ① TOAST typing: Based on X-ray of thoracic part, electrocardiography, blood routine, blood glucose, electrolure, lipid, blood coagulation test, anticardiolipin antibody, antinuclear antibody, anti-double chain DNA, antineutrophil cytoplasmic antibody, crook agglutination test, syphilis antibody and human immunodeficiency virus (HIV) antibody test, patients received TOAST typing, including large-artery atherosclerotic stroke (LA), small-artery occlusion lacunar (SA), cardioembolism (CE), stroke of other demonstrated etiology (SOE), and stroke of other undemonstrated etiology (SUE). ② Risk factors: Stages of hypertension, diabetes mellitus, hyperlipemia, smoking and drinking of patients were observed. Blood pressure was measured twice after onset of acute stroke, and values of total cholesterol (TC) and/or triacylglycerol (TG) were measured more than twice to finally diagnose hyperlipemia. Diagnostic criteria of diabetes mellitus: fasting≥7.0 mmol/L; 2 hours after administrating glucose ≥ 11.1 mmol/L. Risk factor of smoking defined as more than 10 smokes every day in the last year or last several years. Wile, drinking defined as more than twice every weak. Hyperlipemia was measured for twice at least.MAIN OUTCOME MEASURES: TOAST typing and risk factors.RESULTS: All 64 accepted patients were involved in the final analysis. ①TOAST typing: CA counted for 22%, SA for 33%, CE for 19%, SOE for 16%, and SUE for 11%. Among them, percentage of SA was the highest, and there was statistically significance (P＜0.01). ② Analysis of risk factors: Numbers of smoking and drinking were 19 (43%) and 15 (34%) respectively in the males, which was more than those in the females (0, 0, P＜0.01). In addition, numbers of hypertension was more in the females than those in the males [15 (75%), 20 (45%), P ＜ 0.05].CONCLUSION: There are different clinical meanings for different ages in young parients according to TOAST subtypes and risk factors.