基于CISS分型大动脉粥样硬化性脑梗死发病机制与危险因素分析

Analysis of the underlying mechanisms and the risk factors of ischemic stroke of intracranial or extracranial large artery atherosclerosis according to the Chinese Ischemic Stroke Subclassification

目的基于中国缺血性卒中亚型(CISS)分型标准,观察大动脉粥样硬化(LAA)脑梗死各亚型在住院病例中的分布特点,探讨各亚型危险因素的具体特点。方法收集2012年7～12月收治的脑梗死患者,设定严格的入选标准及排除标准,将符合入选条件的脑梗死患者按照CISS分型标准,筛选出颅内外LAA脑梗死进入本研究,并进一步分为4个不同发病机制亚型:载体动脉(斑块或血栓)阻塞穿支动脉、动脉—动脉栓塞、低灌注/栓子清除下降及混合机制。记录各亚型患者的年龄、性别、高血压、糖尿病、血脂异常、吸烟及颈部动脉低回声斑块等危险因素。对各亚型在住院病例中的分布进行描述性研究,比较4个不同亚型之间各危险因素的分布差异。结果在入选的LAA脑梗死患者中,载体动脉(斑块或血栓)阻塞穿支动脉病变型最多见(43例,43.4%),其他依次为动脉—动脉栓塞型(37例,37.4%)、混合机制型(18例,18.2%)、低灌注/栓子清除下降型(1例,1.0%);高龄、高血压、糖尿病、血脂异常、吸烟及低回声斑块在颅内外LAA脑梗死各亚型间比较差异无统计学意义(P>0.05)。结论颅内外LAA脑梗死发病机制以载体动脉(斑块或血栓)阻塞穿支动脉最多见,常见危险因素及低回声斑块在各机制分布无差异。

Objective To investigate the distribution of the underlying mechanisms of ischemic stroke of intracranial or extracranial large artery atherosclerosis（LAA） according to the Chinese ischemic stroke subclassificatian（CISS） and its risk factors. Methods Patients with ischemic stroke in our hospital were collected between July 2012 and December 2012. Setting strict inclusion criteria and exclusion criteria,patients with ischemic stroke of intracranial or extracranial LAA according to the criteria of CISS was enrolled in the study. Next step the underlying mechanism was further divided into the parent artery （ plaque or thrombosis） occluding penetrating artery, artery-to-artery embolism, hypoperfusion/impaired emboli clearance, and multiple mechanisms. Register each subtype patientg age, gender, history of hypertension, history of dyslipidemia, history of dia- betes, smoking and hypoechoic plaques in carotid artery. Make descriptive study on the distribution of subtypes in patients and compare the differences in distribution between 4 different subtypes of various risk factors. Results Among the patients en- rolled, the subtype of parent artery （plaque or thrombus） occluding penetrating accounted for the largest proportion （41 cases, 41.4% ）, followed by the order of artery-to-artery embohsm （37 cases,37.4% ）, multiple mechanism （18 cases, 18.2% ） and hypoperfusion/impaired embolism （ 1 cases, 1.0% ）. There were no significant differences in the aging,hypertension, diabetes, dyslipidemia, smoking history and hypoechoic plaques among the underlying mechanisms （P 〉 0.05）. Conclusion Parent ar- tery （ plaque or thrombus） occluding penetrating is the most common underlying mechanisms of ischemic Stroke of intracranial or extracranial LAA. Common risk factors and hypoechoic plaques showed no significant association with the underlying mecha- nisms of stroke of intracranial or extracranial LAA.