颅内穿支动脉供血区孤立性缺血性脑卒中CISS不同亚型的临床危险因素分析

The analysis of risk factors of different subtypes of CISS typing in isolated penetrating artery territory ischemic stroke

目的探讨颅内穿支动脉供血区孤立性缺血性脑卒中CISS不同亚型的临床危险因素。方法选择78例穿支动脉供血区孤立性缺血性脑卒中患者,根据CISS分型分为大动脉粥样硬化型(LAA)-分支动脉粥样硬化疾病(BAD)42例;穿支动脉疾病(PAD)-BAD19例;PAD-脂质玻璃样变(LD)17例,收集患者的临床资料包括性别、年龄、合并高血压病、合并糖尿病、合并冠心病、饮酒史、吸烟史及Hcy、尿酸、CRP、糖化血红蛋白等,比较各组脑梗死的危险因素。结果PAD-BAD组与LAA-BAD组比较各指标无明显差异(P>0.05);PAD-LD组发病年龄、总胆固醇水平高于LAA-BAD组,脑卒中进展发生率、入院时NIHSS评分、hsCRP水平低于LAA-BAD组(P<0.05);PAD-BAD组发病年龄、HCY水平低于PAD-LD组,LDL、总胆固醇水平、入院时NIHSS评分、脑卒中进展发生率高于PAD-LD组(P<0.05)。结论颅内穿支动脉供血区孤立性缺血性脑卒中3组不同亚型具有不同的临床特征,其中LAA-BAD是最常见类型,与其他两型比较,PAD-LD组发病年龄大,神经功能缺损及脑卒中进展少,HCY及胆固醇水平高,LDL-C水平低,但未发现其相关的独立危险因素。

Objective To investigate the risk factors of different subtypes of CISS in isolated penetrating artery territory ischemic stroke.Methods 78 patients who had isolated penetrating artery territory ischemic stroke were retrospectively investigated.According to the CISS classification,42 patients were large atherosclerotic( LAA)- branch atherosclerotic disease (BAD),there were 19 cases of perforator artery disease (PAD)- BAD,there were 17 cases of PAD-lipid hyaline degeneration(LD),The clinical datas were collected and compared.Results There were no obvious difference in all parameters between PAD-BAD group and LAA-BAD group(P>0.05).The age of onset and total cholesterol level in PAD-LD group were higher than those in LAA-BAD group.The incidence of stroke progression,NIHSS score at admission,and hsCRP level were lower than those in the LAA-BAD group(P<0.05).Age of onset,HCY level in PAD-BAD group were lower than those in PAD-LD group.LDL,total cholesterol level,NIHSS score at admission,stroke progression incidence in PAD-BAD group were higher than those inPAD-LD group(P<0.05).Conclusion LAABAD is the most common type of isolated penetrating artery territory ischemic stroke.Compared with the other two types,PAD-LD was associated with older onset age,lower neurological deficits and stroke progression, higher HCY and cholesterol level,and lower LDL-C level,but no independent risk factors were found.