基于血管成像的缺血性脑卒中亚型分析：1167 例急性连续患者的分析。
Subtyping of ischemic stroke based on vascular imaging: analysis of 1,167 acute, consecutive patients.
机构信息
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
出版信息
J Clin Neurol. 2006 Dec;2(4):225-30. doi: 10.3988/jcn.2006.2.4.225. Epub 2006 Dec 20.
BACKGROUND AND PURPOSE
Knowledge of a patient's cerebral vascular status is essential for accurately classifying stroke. However, vascular evaluations have been incomplete in previous studies, and a stroke registry based on the results of such vascular investigations has not been reported. The purpose of the present study was to classify ischemic strokes based on vascular imaging data.
METHODS
Between May 2001 and August 2003, 1,264 patients with acute (< 7 days) ischemic stroke were admitted to Asan Medical Center. Among them, 1,167 patients (750 men and 417 women; mean age 63.3 years) underwent an angiogram (mostly a magnetic resonance angiogram) and were included in this study. Electrocardiography and computed tomography/magnetic resonance imaging were performed in all patients, while 31.2% underwent echocardiography. The subtypes were categorized with the aid of a modification of the Trial of ORG 10172 in the Acute Stroke Treatment classification.
RESULTS
Large-artery atherosclerosis (LAA) was the most frequent subtype (42%), followed by small-vessel occlusion (SVO, 27%), cardiogenic embolism (CE, 15%), undetermined etiology (15%), and other determined etiology (1.5%). Risk factors included hypertension (71%), cigarette smoking (35%), diabetes mellitus (30%), history of previous stroke (22.7%), emboligenic cardiac diseases (20%), and hypercholesterolemia (11%). Hypertension was more common in patients with SVO than in those with other subtypes (p<0.05), and the case-fatality rate was higher in patients with CE than in those with other subtypes (p<0.01). The functional outcome was worse in patients with LAA than in those with other stroke subtypes (p<0.01).
CONCLUSION
According to the stroke registry based on vascular imaging results, LAA was the most common stroke subtype followed by SVD. The high incidence of LAA is probably related to the increased identification of the presence of intracranial atherosclerosis by MR angiogram.
背景与目的
了解患者的脑血管状况对于准确分类卒中至关重要。然而，既往研究中的血管评估并不完整，且尚无基于此类血管研究结果的卒中登记。本研究旨在基于血管影像学数据对缺血性卒中进行分类。
方法
2001 年 5 月至 2003 年 8 月期间，1264 例急性（<7 天）缺血性卒中患者被收入我院。其中，1167 例（750 例男性，417 例女性；平均年龄 63.3 岁）接受了血管造影（主要为磁共振血管造影），并被纳入本研究。所有患者均接受了心电图和计算机断层扫描/磁共振成像检查，31.2%的患者接受了超声心动图检查。采用改良的急性卒中治疗分类中的 ORG 10172 试验对亚型进行分类。
结果
大动脉粥样硬化（LAA）是最常见的亚型（42%），其次是小血管闭塞（SVO，27%）、心源性栓塞（CE，15%）、病因不明（15%）和其他明确病因（1.5%）。危险因素包括高血压（71%）、吸烟（35%）、糖尿病（30%）、既往卒中史（22.7%）、心源性栓塞性疾病（20%）和高胆固醇血症（11%）。SVO 患者中高血压更为常见（p<0.05），CE 患者的病死率高于其他亚型（p<0.01）。LAA 患者的功能结局较其他卒中亚型更差（p<0.01）。
结论
根据基于血管影像学结果的卒中登记，LAA 是最常见的卒中亚型，其次是 SVD。LAA 发生率较高可能与磁共振血管造影对颅内动脉粥样硬化检出率的提高有关。
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