老年人群不明原因栓塞性卒中与大动脉粥样硬化性卒中的临床特征比较  

Clinical characteristics of embolic stroke of undetermined source and large artery atherosclerotic stroke in the elderly

作　　者：王玮婧 唐晓梅[1] 贾珂[1] 冯浩[1] 刘磊[1] 于逢春[1] Wang Weijing;Tang Xiaomei;Jia Ke;Feng Hao;Liu Lei;Yu Fengchun(Department of Neurology,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院,北京大学第三医院海淀院区神经内科,100080

出　　处：《中华老年心脑血管病杂志》2020年第8期801-804,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市海淀医院院级科研基金(KYQ2017005)。

摘　　要：目的探讨不明原因栓塞性卒中(embolic stroke of undetermined source,ESUS)的临床特征及其与大动脉粥样硬化性卒中(LAA)的区别。方法前瞻性、连续性于2017年1~12月北京市海淀医院神经内科住院的急性缺血性脑卒中患者108例,根据TOAST分型共筛选73例患者,ESUS组26例,LAA组47例。收集2组基线特征,包括美国国立卫生研究院卒中量表(NIHSS)评分和改良的Rankin量表(mRS)评分,比较不同病因急性缺血性脑卒中患者的临床特点和梗死部位。结果ESUS组NIHSS评分明显高于LAA组[3(2,5)分vs 1(1,4)分,P=0.000],mRS评分≤2分比例明显低于LAA组(73.1%vs 100.0%,P=0.000)。ESUS组梗死部位前后循环均累及6例,LAA组2例(23.1%vs 4.3%);ESUS组梗死部位双侧累及8例,LAA组4例(30.8%vs 8.5%),差异有统计学意义(P<0.05)。NIHSS评分是影响老年ESUS及LAA患者30 d致残的独立危险因素(OR=2.333,95%CI:1.006~5.410,P=0.048;OR=1.390,95%CI:1.094~1.768,P=0.007)。结论ESUS在病变分布双侧受累及前后循环均受累较为多见,其临床严重程度较LAA更重。Objective To study the clinical characteristics of embolic stroke of undetermined source(ESUS)and the difference between ESUS and LAA.Methods Seventy-three out of the 108 acute ischemic stroke(AIS)patients admitted to our hospital from January to December 2017 were divided into ESUS group(n=26)and LAA group(n=47)according to TOAST classification.Their NIHSS score and mRS score were recorded.The clinical characteristics and infarction sites were compared in AIS patients with different etiologies.Results The NIHSS score and mRS score were significantly higher while the rate of mRS score≤2 was significantly lower in ESUS group than in LAA group[3(2,5)vs 1(1,4),P=0.000;73.1%vs 100.0%,P=0.000].The anterior circulation and posterior circulation were involved in 6 patients(23.1%)of ESUS group and in 2 patients(4.3%)of LAA group.Both anterior circulation and posterior circulation were involved in 8 patients(30.8%)of ESUS group and in 4 patients(8.5%)of LAA group(P<0.05).The NIHSS score was an independent risk factor for the 30-day disability in elderly ESUS and LAA patients(OR=2.333,95%CI:1.006-5.410,P=0.048;OR=1.390,95%CI:1.094-1.768,P=0.007).Conclusion ESUS is common in the elderly with both anterior circulation and posterior circulation involved and is severer than LAA,suggesting that ESUS is a special type of embolic stroke and its pathogenesis needs to be further studied.

关 键 词：梗死 大脑中动脉 卒中 动脉粥样硬化 血栓栓塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]