基于CISS分型的进展性卒中危险因素及短期预后分析

The analysis of stroke in progression risk factors and short-term prognosis based on CISS classification

目的探讨基于CISS分型的进展性卒中(SIP)危险因素及短期预后分析,为优化进展性卒中的诊疗方案提供参考。方法选取自2016年11月至2017年2月于哈尔滨医科大学附属第一医院神经内科住院治疗的SIP患者共58例,观察并记录入组患者在发病时、发病后48h、72h、7d的SSS评分。根据临床资料得出患者的CISS分型,依CISS分型分为五组:大动脉粥样硬化组(LAA),心源性卒中组(CS),穿支动脉疾病组(PAD),其他病因组(OE),病因不确定组(UE)。结果对基于CISS分型的SIP患者的危险因素进行分析,高龄、房颤在CS组占比最大,高血压病、糖尿病、冠心病在PAD组占比最大,吸烟史在LAA组占比最大。对早发型、迟发型的SIP的各危险因素进行分析,比较差异无统计学意义。对入组患者发病时、发病后48h、72h、7d的SSS评分进行分析,PAD组SSS评分均最高,即症状较轻,CS组SSS评分均较低,即症状较重。结论高龄、房颤者易患进展性心源性卒中;高血压病、糖尿病、冠心病者易患进展性穿支动脉疾病;有吸烟史者易患大动脉粥样硬化型SIP;SIP的患者,穿支动脉疾病组短期预后良好,心源性卒中组短期预后较差。

Objective To explored stroke in progression （ SIP ） risk factors and short-term prognosis based on CISS classification, and provided a reference for optimizing the diagnosis and treatment of SIP. Method We took fifty-eight hospitalized patients with the diagnosis of SIP in the departments of neurology, First Affiliated Hospital of Harbin Medical University from November 2016 to February 2017, then observed and recorded the SSS score of the patient at the time of the stroke onset, 48 hours, 72 hours, and 7 days. We divided the patients into five groups according to the CISS classification inferred from the clinical informations, that is large artery atherosclerosis （ LAA ） , cardiogenic stroke （ CS ） , penetrating artery disease （ PAD ） , other etiology （ OE ） , undetermined etiology （ UE ） . Results We analyzed the risk factors of SIP patients based on CISS classification, advanced age and atrial fibrillation accounted for the largest in CS group, hypertension, diabetes mellitus, coronary heart disease accounted for the largest in PAD group, smoking history accounted for the largest in LAA group. The risk factors for early SIP and late SIP were analyzed, the component comparison were no significant difference. The SSS score of the patients include at the time of the stroke onset, 48 hours, 72 hours, and 7 days were analylzed, the PAD group was the highest, that was, the symptoms were relatively mild, the CS group was relatively lower, that was, the symptoms were relatively seriously. Conclusion The advanced aged, arterial fibrillation patients are susceptible to progressive cardiogenic stroke; the hypertension, coronary heart disease patients are susceptible to progressive penetrating artery disease; the patients with a history of smoking were susceptible to progressive lagre artery atherosclerotic stroke; for the patients suffered from progressive stroke, the symptoms and the short-term prognosis of the PAD group were relatively mild, the symptoms and the short-term prognosis of the CS group were relatively seriously.