本文選題：腦梗死 + CISS分型�。� 參考：《河南科技大學(xué)》2013年碩士論文

【摘要】：目的：基于CISS分型（chinese ischemic stroke subclassification，CISS）對急性腦梗死(Acute cerebral infarction，ACI)患者進(jìn)行中國缺血性卒中亞型分析，統(tǒng)計進(jìn)展性腦梗死與非進(jìn)展性腦梗死患者各亞型的構(gòu)成比、病灶分布、影像學(xué)特點、病因及發(fā)病機(jī)制的差別，并探討進(jìn)展性腦梗死的危險因素。 方法：連續(xù)性登記2011年10月1日至2012年10月31日入住河南科技大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科的ACI患者，，入院后立即接受神經(jīng)科常規(guī)查體，并行血糖、血常規(guī)、血凝、肝功能、腎功能、同型半胱氨酸和血甘油三酯、膽固醇、低密度脂蛋白、高密度脂蛋白等實驗室檢查；同時記錄患者的個人史(性別、年齡)、卒中的危險因素(高血壓史、糖尿病史、既往卒中史、冠心病史、高脂血癥史及吸煙史)。所有病人均于入院當(dāng)時即做頭顱CT檢查，排除了出血性卒中。結(jié)合其MRI/DWI/CT、頸動脈彩超、CTA/MRA等檢查結(jié)果，依據(jù)中國缺血性卒中亞型標(biāo)準(zhǔn)對其進(jìn)行分型，包括對LAA(large artery therosclerosis)亞型發(fā)病機(jī)制的分析。統(tǒng)計進(jìn)展性腦梗死與非進(jìn)展性腦梗死患者各亞型的構(gòu)成比、病灶分布、影像學(xué)特點、病因及發(fā)病機(jī)制的差別，并探討進(jìn)展性腦梗死的危險因素。 結(jié)果：328例ACI患者，根據(jù)病情變化分為進(jìn)展組（發(fā)病6小時后至一周內(nèi)經(jīng)過治療或未治療其病情仍然進(jìn)展，NIHSS評分增加2分或以上者）與非進(jìn)展組（發(fā)病6小時后至一周內(nèi)未經(jīng)過治療或經(jīng)治療后病情平穩(wěn)，未再進(jìn)展，NIHSS評分減少、不變或增加小于2分者），其中進(jìn)展組51例，非進(jìn)展組277例。進(jìn)展組51例中39例屬大動脈粥樣硬化(LAA)，占76%，4例屬心源性卒中(CS)，占8%，5例屬穿支動脈疾病(PAD)，占10%，2例屬病因不確定(UE)，占4%，1例屬其它病因（OE），占2%，39例大動脈粥樣硬化的發(fā)病機(jī)制分型為：動脈到動脈栓塞11例（28%），載體動脈（斑塊或血栓）阻塞穿支動脈3例（8%），低灌注/栓子清除下降17例（43%），混合型8例（21%）。非進(jìn)展組277例中205例屬大動脈粥樣硬化(LAA)，占74%，21例屬心源性卒中(CS)，占8%，26例屬穿支動脈疾病(PAD)，占9%，20例屬病因不確定(UE)，占7%，5例屬其它病因（OE），占2%。205例大動脈粥樣硬化的發(fā)病機(jī)制分型為：動脈到動脈栓塞96例（47%），載體動脈（斑塊或血栓）阻塞穿支動脈17例（8%），低灌注/栓子清除下降21例（10%），混合型71例（35%）。 進(jìn)展組占總數(shù)的17%左右，進(jìn)展組人群糖尿病發(fā)生率顯著高于非進(jìn)展組(P0．001，P0．05)，發(fā)病年齡、高血壓發(fā)生率均高于非進(jìn)展組，但差異無統(tǒng)計學(xué)意義；兩組之間比較在性別、高膽固醇血癥、吸煙史差異無統(tǒng)計學(xué)意義。 影像學(xué)檢查結(jié)果（頭部MRI+DWI+MRA）顯示進(jìn)展組額、顳、頂葉梗死7例；基底節(jié)區(qū)3例，腦干梗死3例，小腦梗死1例；分水嶺梗死37例。采用Bogouss-lavsky神經(jīng)影像學(xué)分類法，按照腦血管分布影像模板，分水嶺腦梗死分為皮質(zhì)前型7例，皮質(zhì)下型14例，皮質(zhì)后型6例，混合型10例。非進(jìn)展組額、顳、頂葉梗死32例，基底節(jié)區(qū)192例；腦干梗死13例，小腦、枕葉梗死12例；分水嶺梗死28例，采用Bogouss-lavsky神經(jīng)影像學(xué)分類法，按照腦血管分布影像模板，分水嶺腦梗死分為皮質(zhì)前型12例，皮質(zhì)下型8例，皮質(zhì)后型6例，混合型2例。與非進(jìn)展組比較，進(jìn)展組分水嶺梗死發(fā)生率較高，兩組之間有顯著性差異(P0．001)。 根據(jù)血管狹窄標(biāo)準(zhǔn)，51例進(jìn)展組中32例存在大動脈中重度狹窄或閉塞(占62.7%)，其中頸內(nèi)動脈顱內(nèi)段狹窄9例，大腦中動脈狹窄或閉塞18例，椎基底動脈狹窄5例；而277例非進(jìn)展組，75例存在大動脈中重度狹窄或閉塞(占27%)，頸內(nèi)動脈顱內(nèi)段狹窄24例，大腦中動脈狹窄39例，椎基底動脈狹窄者為12例。進(jìn)展組大動脈中重度狹窄或閉塞發(fā)生率顯著高于非進(jìn)展組(P0．001)，且病變血管主要發(fā)生在頸內(nèi)動脈系統(tǒng)。 328例急性腦梗死患者中，男性192例(58.53％)，女性136例(41.47％)，血漿同型半胱氨酸(Hcy)22.54±13.57mol／L。進(jìn)展組Hcy是24.70±14.47mol／L；非進(jìn)展組Hcy是19.89±10.67mol／L，兩組之間差異有統(tǒng)計學(xué)意義(P0．05). 結(jié)論：ACI患者的病灶分布及影像學(xué)特點與CISS亞型相關(guān)。CISS分型病因以大動脈粥樣硬化比例最高，機(jī)制以動脈到動脈栓塞和低灌注/栓子清除下降最為常見；從影像上看分水嶺區(qū)梗死進(jìn)展率較高，尤其皮質(zhì)下型和混合型預(yù)示可能發(fā)生進(jìn)展；糖尿病、顱內(nèi)外血管狹窄或閉塞、高同型半胱氨酸血癥也與急性缺血性腦卒中早期神經(jīng)功能惡化有關(guān)。
[Abstract]:Objective: to analyze the ischemic stroke subtype of acute cerebral infarction (Acute cerebral infarction, ACI) in patients with acute cerebral infarction (Acute cerebral infarction, ACI) based on the Chinese ischemic stroke subclassification (CISS), and to determine the constituent ratio of the subtypes of the progressive cerebral infarction and the non progressive cerebral infarction, the distribution of the focus, the imaging features, the etiology and the pathogenesis of the CISS stroke subclassification. Difference, and explore the risk factors of progressive cerebral infarction.
Methods: ACI patients were enrolled in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology from October 1, 2011 to October 31, 2012, and received routine neurology examination after admission. Blood glucose, blood routine, hemagglutination, liver function, renal function, homocysteine and triglyceride, cholesterol, low density lipoprotein, high density fat were also accepted immediately after admission. Laboratory tests, such as protein, and the individual history of patients (sex, age), risk factors for stroke (hypertension, diabetes, past stroke, coronary heart disease, hyperlipidemia, and smoking history). All patients were performed head CT at the time of admission, excluding hemorrhagic stroke, combined with MRI/DWI/CT, carotid color Doppler ultrasound, CTA/MRA The results were classified according to the Chinese ischemic stroke Central Asian type standard, including the analysis of the pathogenesis of LAA (large artery therosclerosis) subtype. The constituent ratio of the subtypes of the progressive cerebral infarction and the non progressive cerebral infarction, the distribution of the focus, the imaging characteristics, the difference of the etiology and pathogenesis were analyzed, and the progress was discussed. The risk factors of cerebral infarction.
Results: 328 patients with ACI were divided into a progressive group according to the change of the condition (6 hours after the onset of the disease or a week after treatment or untreated progress, the NIHSS score increased by 2 or more) and the non progression group (6 hours after the onset of the disease was untreated or treated without any further progression, the NIHSS score decreased, unchanged or increased. " There were 51 cases in progress group and 277 cases in non progression group. 39 cases in 51 cases were large atherosclerosis (LAA), 76%, 4 cases of cardiogenic stroke (CS), 8%, 5 cases of perforator artery disease (PAD), 10%, 2 of etiology uncertainty (UE), 4%, 1 cases (OE), accounting for the pathogenesis of large atherosclerosis 11 cases (28%) of arterial to arterial embolism, 3 cases of perforating artery occlusion (8%), 17 cases (43%) and 8 cases (21%) of low perfusion / embolus, 205 cases of large atherosclerosis (LAA), 74%, 21 cases of cardiogenic apoplexy (CS), 17 cases of perforator artery disease (PAD). Because of uncertainty (UE), accounting for 7%, 5 were other causes (OE), accounting for the pathogenesis of major atherosclerosis in 2%.205: artery to arterial embolism (47%), carrier artery (plaque or thrombus) blocking perforating artery in 17 cases (8%), low perfusion / embolic reduction in 21 cases (10%), and mixed type 71 (35%).
The progression group accounted for about 17% of the total, and the incidence of diabetes in the progressive group was significantly higher than that in the non progressing group (P0.001, P0.05). The age of onset and the incidence of hypertension were higher than those in the non progressing group, but the difference was not statistically significant. There was no statistical difference between the two groups in sex, hypercholesterolemia and smoking history.
Imaging examination results (head MRI+DWI+MRA) showed 7 cases of progressive group, temporal and parietal infarction, 3 cases in basal ganglia, 3 cases of brain stem infarction, 1 cases of cerebellar infarction, 37 case of watershed infarction. The Bogouss-lavsky neuroimaging classification method was used to classify the cerebral vessels in 7 cases, 14 cases of subcortical type, and 14 cases of subcortical type. There were 6 cases of post mass, 10 cases in mixed type, 32 cases of temporal, parietal lobe infarction, 192 cases of basal ganglia, 13 cases of brain stem infarction, 12 cases of cerebellum, 12 case of occipital lobe infarction, 28 cases of watershed infarction, using Bogouss-lavsky neuroimaging classification method, according to the imaging template of cerebral vascular distribution, divided into 12 cases of anterior cortical type, 8 cases subcortical type, 8 cases of subcortical type, and cortex subcortical type 8 cases. There were 6 cases of posterior type and 2 cases of mixed type. Compared with the non progressive group, the incidence of watershed infarction was higher in the progressive group, and there was a significant difference between the two groups (P0.001).
According to the standard of vascular stenosis, 32 cases in the 51 progressive group had severe stenosis or occlusion of the large artery (62.7%), including 9 cases of intracranial stenosis in the internal carotid artery, 18 cases of middle cerebral artery stenosis or occlusion, 5 cases of vertebral basilar artery stenosis, 277 cases of non progressive group, 75 cases with severe stenosis or occlusion of the large artery (27%), and intracranial stenosis of the internal carotid artery. Narrowing of 24 cases, middle cerebral artery stenosis in 39 cases, and vertebrobasilar stenosis in 12 cases. The incidence of severe stenosis or occlusion in the advanced artery was significantly higher than that in the non progression group (P0.001), and the lesion vessels mainly occurred in the internal carotid artery system.
Among the 328 patients with acute cerebral infarction, 192 (58.53%), 136 (41.47%) for women, 24.70 + 14.47mol / L in plasma homocysteine (Hcy) 22.54 + 13.57mol / L., and 19.89 + 10.67mol / L in non progression group, and the difference between the two groups was statistically significant (P0.05).
Conclusion: the lesion distribution and imaging features of ACI patients with CISS subtype related.CISS types are most common in the proportion of large atherosclerosis, and the most common mechanism is arterial to arterial embolism and low perfusion / embolic reduction. The incidence of infarct in the watershed is high, especially in the subcortical and mixed types. Progression, diabetes, intracranial or extracranial artery stenosis or occlusion, hyperhomocysteinemia are also associated with early deterioration of neurological function in acute ischemic stroke.

【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.3

【共引文獻(xiàn)】

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