基于COIST分型的儿童动脉缺血性卒中病因及短期预后分析  

Analysis of etiology and short-term prognosis of childhood arterial ischemic stroke based on the COIST classification

作　　者：于泽谋 贾静静 李久伟[1] 孟令丙 周季 张炜华[1] 熊晖 方方[1] 卓秀伟[1] Yu Zemou;Jia Jingjing;Li Jiuwei;Meng Lingbing;Zhou Ji;Zhang Weihua;Xiong hui;Fang fang;Zhuo Xiuwei(Department of Neurology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of Cardiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院神经内科,北京100045 [2]北京清华长庚医院心脏内科清华大学临床医学院,北京102218

出　　处：《中华医学杂志》2025年第3期225-232,共8页National Medical Journal of China

基　　金：国家自然科学基金(82304864)。

摘　　要：目的基于COIST分型,分析中国儿童动脉缺血性卒中(AIS)的病因及短期预后。方法回顾性纳入2015年9月至2024年4月期间北京儿童医院收治的380例首次确诊的AIS患儿,根据COIST分型进行病因分析。将患儿按年龄分为婴幼儿组(>28 d且≤3岁)117例;学龄前期组(>3岁且≤7岁)90例;学龄期组(>7岁且≤11岁)90例;青少年组(>11岁且≤18岁)83例。进一步分析不同年龄儿童病因占比及不同病因患儿短期预后。结果380例患儿中男235例(61.8%),女145例(38.2%),就诊年龄(6.6±4.6)岁;约2/3的患儿就诊于神经内科,该部分患儿住院天数(13.2±6.7)d。(1)病因分析:“血管结构异常”占比最高,为38.2%(145/380),其他类型依次为“炎症性”31.1%(118/380),“原因不能确定”11.1%(42/380),“其他可确定病因”9.2%(35/380),“心脏疾病”6.3%(24/380),“易栓症”4.2%(16/380)。(2)不同年龄组病因分析:婴幼儿组“血管结构异常”占比47.9%(56/117),以轻微外伤后基底节区脑梗死(合并基底节钙化)最多见(40/117);学龄前期组“炎症性”和“血管结构异常”分别有34例(34/90)和33例(33/90);亚组中烟雾病最多见(15/90);学龄期组“血管结构异常”有37例(37/90),亚组中动脉夹层最多见(12/90),其次为局灶性脑动脉病-炎症型(FCA-i)(11/90)和烟雾病(11/90);青少年组“炎症性”有34例(34/83),亚组中FCA-i占比最高(13/83),其次为易栓症(9/83)和系统性红斑狼疮(8/83)。(3)短期预后:儿童卒中结局量表(PSOM)评估短期预后,预后良好共188例,占比49.5%(188/380),预后不良共192例,占比50.5%(192/380);改良Rankin量表(mRS)评分评估短期预后,预后良好207例(54.5%),预后不良173例(45.5%)。亚类“炎症性-非感染性”,以及FCA-i、烟雾病和动脉夹层相对预后较好;“其他可确定病因”预后良好占比<1/3;出院时死亡14例,总病死率3.7%。结论血管结构异常及炎症性(包括感染性和非感染性)是儿童AIS的主要病因;约1/Objective This study aims to analyze the etiology and short-term prognosis of childhood arterial ischemic stroke(AIS)in Chinese children,based on the COIST classification system.Methods A total of 380 pediatric patients with a first-ever diagnosis of AIS treated at Beijing Children's Hospital between September 2015 and April 2024 were retrospectively included.Etiology was analyzed according to COIST classification.The patients were categorized into infant and toddler group with 117 cases(>28 days to≤3 years),preschool group with 90 cases(>3 years to≤7 years),school-age group with 90 cases(>7 years to≤11 years),and adolescent group with 83 cases(>11 years to≤18 years).The etiological distribution across age groups and the short-term prognosis of patients with different etiologies were further analyzed.Results Among the 380 patients,235 were male(61.8%)and 145 were female(38.2%),with a mean age at presentation of(6.6±4.6)years.Approximately 2/3 of the patients were admitted in the Department of Neurology,with a mean hospital stay of(13.2±6.7)days.(1)Etiological analysis:"Vascular structural abnormalities"were the most common cause,accounting for 38.2%(145/380),followed by"Inflammatory"causes at 31.1%(118/380),"Undetermined"at 11.1%(42/380),"Other identifiable causes"at 9.2%(35/380),"Cardiac diseases"at 6.3%(24/380),and"thrombophilia"at 4.2%(16/380).(2)Etiological distribution by age group:in the infant and toddler group,"vascular structural abnormalities"were 47.9%(56/117),with basal ganglia infarction following minor trauma(combined with basal ganglia calcification)being the most common(40/117).In the preschool group,there were 34 cases(34/90)of"inflammatory"and 33 cases(33/90)of"vascular structural abnormalities",with Moyamoya disease being the most frequent cause(15/90).In the school-age group,there were 37(37/90)cases of"vascular structural abnormalities",with arterial dissection(12/90)being the most common,followed by FCA-i(11/90),and Moyamoya disease(11/90).In the adolescent group,there were 34 case

关 键 词：卒中 动脉缺血性卒中 儿童 病因 分型 短期预后 病例系列研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]