170例急性脑梗死CISS分型及相关危险因素分析  

China Ischemic Stroke Subclassincation Subclassincation and Related Risk Factors of 170 cases of Ischemic Stroke

作　　者：马中华[1] 孙林[1] 田国红[1] 张晓君[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京市100730

出　　处：《中国卒中杂志》2011年第10期772-777,共6页Chinese Journal of Stroke

基　　金：北京市高层次卫生技术人才培养计划(2009-2-09)

摘　　要：目的按照中国缺血性卒中分型(China Ischemic Stroke Subclassification,CISS)标准,观察各类型脑梗死在住院患者中的分布,探讨常见危险因素在各类型脑梗死中分布的差异性。方法 2011年3月至2011年7月住我院急性脑梗死患者完成超声、影像学及相关实验室检查,按照CISS进行病因和病理机制分型,回顾性分析住院患者不同病因脑梗死的比例,分析高血压、糖尿病、脂代谢紊乱、心脏病、吸烟等常见危险因素在不同脑梗死类型中分布差异性。结果入组病例170例。经CISS病因分型,大动脉粥样硬化性脑梗死128例(75.3%),心源性脑梗死25例(14.7%),穿支动脉病变14例(8.2%),其他原因1例(0.6%),不明原因2例(1.2%)。大动脉粥样硬化性脑梗死病理机制分型:载体动脉阻塞穿支87例、动脉-动脉栓塞24例、低灌注/栓子清除障碍17例、多种机制0例。在病因分型中各组患者合并高血压的比例最高,平均为81.1%,但在各组之间分布差异无统计学意义;大动脉粥样硬化性脑梗死患者合并脂代谢紊乱比例高于心源性卒中组(58.6% vs 32.0%,P=0.015)和穿支动脉疾病组(58.6% vs 28.6%,P=0.032),后二者比较差异无统计学意义(32.0% vs 28.6%,P=1.000);另外,大动脉粥样硬化性脑梗死患者吸烟史的比例明显高于心源性卒中组(47.7% vs 20.0%,P=0.011)及其他各组;心源性脑梗死合并心脏病比例高于大动脉粥样硬化性脑梗死组(100% vs 32.0%,P=0.000)及其他各组;穿支动脉病变患者合并糖尿病比例显著高于心源性卒中组(57.1% vs 12.0%,P=0.007),但与大动脉粥样硬化性脑梗死组相比差异无统计学意义(57.1% vs 29.7%,P=0.067),而后二者比较差异也无统计学意义(P=0.068)。而上述危险因素在大动脉粥样硬化性脑梗死病理机制分型各亚组中的分布差异无统计学意义。结论 CISS分型中大动脉粥样硬化性脑梗死是急性脑梗死最常见的病因类型,其中以载体动脉阻塞穿支为最常Objective To investigate the distribution of different acute ischemic stroke subtypes according to the China ischemic stroke subclassification（CISS） criteria and its related risk factors. Methods One hundred and seventy patients with acute ischemic stroke in our hospital were collected from March 2011 through July 2011. The clinical characteristic and examination results of each patient including blood test, ultrasound and brain computed tomography/magnetic resonance imaging were collected. All patients were subclassified according to the CISS criteria. Retrospective analysis of the proportion of each subtype of acute ischemic stroke in in-patient was taken. The presentation of common risk factors（hypertension, diabetes mellitus, lipid disorders, heart diseases and smoke history） in each group were measured and compared with others. Results Among the 170 patients studied, the etiology subtypes included 128 cases（75.3%） of large artery atherosclerosis（LAA）, 25 cases（14.7%） of cardiogenic stroke（CS）, 14 cases（8.2%） of penetrating artery disease（PAD）, 1 in other etiologies, and 2 in undetermined etiology. The underlying mechanism subtypes included 87 patients of parent artery（plaque or thrombus） occluding penetrating artery, 24 cases of artery-to-artery embolism, 17 cases of hypoperfusion/ impaired emboli clearance and 0 case of multiple mechanism. Hypertension was the most common condition（81.1%） but no statistically difference was found among the CISS groups. Lipid metabolic disorder and smoke history were found in 75（58.6%） and 61（47.7%） of LAA group, which is statistically higher than those of the other two groups（P〈0.05）. While the frequency of patients with heart diseases（100%） in CS group was statistically higher than the other groups（P〈0.01）, patients with diabetes mellitus（57.1%） was significantly more common in PAD（P〈0.05）. No further significantly difference was found among different subtypes regarding the related risk factors. Conc

关 键 词：脑梗死 中国缺血性卒中分型 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]