按CISS分型分析急性脑梗死的危险因素

Analysis of risk factors of acute cerebral infarction by CISS classification

目的：根据中国缺血性卒中分型（CISS）标准，分析不同病因脑梗死在住院患者中的分布情况，并进一步探讨脑血管疾病常见危险因素在不同类型脑梗死中的分布差异，总结其临床特点。方法：采集2014年1月～2015年12月西南医科大学附属医院神经内科住院部收治的急性期脑梗死患者资料，首先按照CISS进行分型，然后分析不同危险因素在各类型脑梗死中的分布差异。结果：在入选的105例患者CISS病因分型中：大动脉粥样硬化（LAA）组75例（71．4％），心源性卒中（CS）组10例（9．5％），穿支动脉疾病（PAD）组22例（21％），其他病因（OE）组1例（1％），不明病因（UE）组2例（1.9％）。其中LAA病理机制分型：载体动脉阻塞穿支15例，动脉一动脉栓塞49例，低灌注和（或）栓子清除障碍导致6例，多种机制导致4例。血压、总胆固醇、甘油三酯、低密度脂蛋白、C反应蛋白、红细胞压积及纤维蛋白原升高等危险因素在各病因分型间均无总体差异，仅糖尿病（P=0．009）、同型半胱氨酸升高（P=0．032）和心房纤颤（P=O）存在总体差异。PAD组合并糖尿病比例明显高于LAA组（P=0．002），但与CS组比较无明显差异（P=0．212）。LAA组及CS组合并同型半胱氨酸升高的比例高于PAD组（P=0．026和P=0．009），而同型半胱氨酸升高在LAA组及CS组间分布无差异（P=0．300）。CS组合并心房纤颤比例较LAA组及PAD组高（均为P=0．000），但后两者比较差异无统计学意义（P=0．829）。结论：急性脑梗死CISS病因分型以LAA最常见，病理机制以动脉-动脉栓塞所占比例最高，不同CISS分型的急性期脑梗死明显相关的危险因素有所不同，可为个体化治疗提供参考。

Objective：To analyze the distribution of various types of cerebral infarction in hospital- ized patients by China Ischemic Stroke Subclassification （CISS）, and to further explore the distribution of common risk factors of cerebrovascuar diseases in different types of cerebral infarction and summarize its clinical characteristics. Methods：The data of patients with acute cerebral infarction admitted to the De- partment of Neurology, the Affiliated Hospital of Southwest Medical University from January 2014 to December 2015 were collected and classified according to CISS. Then the distribution difference of vari- ous risk factors in different types of cerebral infarction were analyzed. Results： Out of 105 patients en- rolled in the CISS etiological classification, large artery atherosclerosis （LAA） were found in 75 cases （71.4%）, cardiogenic stroke （CS） in 10 cases （9.5%）, penetrating artery disease （PAD） in 22 cases （21%）, other etiologies（OE） in 1 case （1%）, undetermined etiology （UE） in 2 cases （1.9%）. In LAA type, there were 15 cases caused by arterial occlusion of perforating branches, 49 cases by arterial embo- lization, 6 cases by low perfusion / clear obstruction of the arteries and 4 cases by multiple mechanism. There was no overall difference in etiological classification of risk factors for acute cerebral fibrosis causedby high blood pressure, total cholesterol, and triglyceride, low density lipoprotein, C reactive protein, hematocrit and fibrinogen, except for diabetes mellitus （P=0. 009）, elevated homocysteine （P=0. 032） and atrial fibrillation （P=0） only. The proportion of PAD with diabetes was significantly higher than that of LAA （P=0. 002）, but there was no significant difference from CS （P=0. 212）. The proportion of elevated homocysteine in LAA and CS groups was higher than the proportion of PAD （P=0. 026, 0. 009）, and the distribution of homocysteine in LAA and CS had no difference （P=0. 300）. There was a significant difference between the two groups （P= 0）, but the difference between the two groups was not statistically significant （P = 0. 8：79）. Conclusion： In southern Sichuan, LAA is the most common cause of CISS in acute cerebral infarction, with the highest ratings of arterial embolism, and the risk fac- tors of acute cerebral infarction with different CISS subtypes are different, which provides reference for individualized treatment.