Clinical Characteristics of Acute Ischemic Stroke Based on Multiple Imaging Evaluation
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摘要:
目的 分析联合多重影像评估的急性缺血性脑卒中临床特征。 方法 联合多重影像评估首都医科大学宣武医院2014年1月至2018年12月收治的8441例急性缺血性脑卒中的发生占比、动脉血管病理改变、梗塞责任血管以及梗死机制。 结果 （1）男性发生占比高于女性（74.7% vs 25.3%； P < 0.001）而发病年龄则小于女性[（58.83±12.56）岁 vs （63.37±13.27）岁； P < 0.0001]，50～69岁为急性缺血性脑卒中发病高峰期（57.87%）；（2）高血压、糖尿病和高脂血症为急性缺血性脑卒中主要危险因素，高血压为最常见危险因素（28.65%）；（3）动脉粥样硬化（62.9%）是急性缺血性脑卒中动脉管壁最主要病理改变，也是最常见病因；39.2%的患者存在大脑中动脉狭窄闭塞；（4）67.49%的急性缺血性脑卒中发生于颅内动脉，前循环急性缺血性脑卒中发生率（58.33%）高于后循环（33.47%），差异有统计学意义（ P < 0.0001）；（5）动脉到动脉栓塞、局灶穿枝动脉闭塞，低灌注栓子清除障碍是急性缺血性脑卒中常见发病机制，其中动脉到动脉栓塞为主要发病机制。 结论 多重影像评估的大样本的急性缺血性脑卒中的发病年龄、不同性别发病占比、动脉血管病理改变、责任血管发生率以及急性缺血性脑卒中发生机制对指导临床急性缺血性脑卒中的急救、二级预防、早期筛查及预防具有一定的指导作用。 Abstract:Objective To analyze the clinical characteristics of acute ischemic stroke combined with multiple imaging assessment. Methods Multiple images were combined to evaluate the incidence, arterial pathological changes, the responsible vessels for infarction, and infarct mechanism of 8441 acute ischemic strokes admitted to Xuanwu Hospital of Capital Medical University from 2014 to 2018. Results （1） The incidence of males was higher than that of females （74.7% vs 25.3%; P < 0.001） and the age of onset was smaller than females （58.83±12.56 years vs 63.37±13.27 years; P < 0.0001）, 50-69 years old was the peak period of acute ischemic stroke （57.87%）; （2） Hypertension, diabetes and hyperlipidemia are the main risk factors for acute ischemic stroke, and hypertension is the most common risk factor （28.65%）; （3） Atherosclerosis （62.9%） is the most important pathological change and the most common cause of the arterial wall in acute ischemic stroke; 39.2% of patients have middle cerebral artery stenosis and occlusion; （4） 67.49% of acute ischemia strokeoccurs in the intracranial artery. The incidence of the anterior circulation （58.33%） is higher than that in the posterior circulation （33.47%）, and the difference is statistically significant （ P < 0.0001）; （5） Arterial-to-arterial embolism , local penetrating arterial occlusion and hypoperfusion impaired emboli clearance are common mechanism of acute ischemic stroke, of which arterial-to-arterial embolism is the main mechanism. Conclusion The age of onset of acute ischemic stroke, the proportion of different sexes, the pathological changes of arteries, the incidence of responsible blood vessels, and the mechanism of acute ischemic stroke of a large sample of acute ischemic stroke evaluated by multiple images can guide clinical acute ischemic stroke First aid, secondary prevention, early screening and prevention of stroke have a certain guiding role. -
Key words:
- Image /
- Acute ischemic stroke /
- Clinical characteristics
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图 1 不同年龄段急性缺血性脑卒中发病占比（%）
Figure 1. The proportion of acute ischemic stroke in different age groups （%）
图 2 男女不同年龄段急性缺血性脑卒中发病占比
Figure 2. The proportion of acute ischemic stroke in men and women of different ages
图 3 前循环与后循环的急性缺血性脑卒中发生率（%）
Figure 3. The incidence of acute ischemic stroke in anterior circulation and posterior circulation （%）
图 4 急性缺血性脑卒中颅内动脉发生率（%）
Figure 4. The incidence of intracranial artery in acute ischemic stroke （%）
表 1 急性缺血性脑卒中发病占比[n（%）]
Table 1. The proportion of acute ischemic stroke [n（%）]
年龄（岁） 总计 男性例数 女性例数 P 18～19 26（0.30） 17（0.27） 9（0.42） 0.265 20～29 100（1.18） 66（1.05） 34（1.59） 0.049* 30～39 417（4.94） 355（5.63） 62（2.90） 0.000* 40～49 1074（12.72） 885（14.03） 189（8.85） 0.000* 50～59 2325（27.54） 1902（30.17） 423（19.80） 0.000* 60～69 2560（30.35） 1856（29.44） 704（32.96） 0.002* 70～79 1413（16.74） 908（14.40） 505（23.65） 0.000* 80～89 497（5.89） 298（4.72） 199（9.32） 0.000* >90 29（0.34） 18（0.29） 11（0.51） 0.134 合计 8441（100.0） 6305（100.0） 2136（100.0） 男性与女性不同年龄段急性缺血性脑卒中发病占比的比较，*P<0.05。 
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表 2 危险因素[n（%）]
Table 2. Risk factors [n（%）]
危险因素 病例数 高血压 2419（28.65） 高脂血症 948（11.23） 糖尿病 934（11.06） 脑卒中史 788（9.33） 高同型半胱氨酸血症 297（3.52） 心脏因素 心房纤颤 193（2.32） 风心病 30（0.35） 心肌病 15（0.18） 卵圆孔未闭 45（0.53） 房间隔缺损 12（0.14） 糖耐量异常 29（0.34） 睡眠呼吸暂停综合症 9（0.11） 动脉夹层 133（1.6）
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表 3 头颅多重影像的评估率[n（%）]
Table 3. The evaluation rate of multiple images of head [n（%）]
评估内容 病例数 血管影像学 头颈部CDU+TCCD 8435（99.93） 头颈部动脉CTA 5987（70.92） 全脑DSA 3082（36.57） 颅内动脉HR-MRI 343（4.06） 颅内动脉MRA 153（1.81） 结构影像学 头颅MRI+DWI 5812（68.85） 头颅CT平扫 1604（19.00） 功能影像学 头颅CTP 389（4.61） 头颅PWI 39（0.46） 头颅PET-CT 17（0.20）
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表 4 多重影像评估的动脉壁病理改变[n（%）]
Table 4. The pathological changes of arterial wall assessed by multiple images [n（%）]
动脉壁病理改变 病例数 动脉硬化发生率 5306（62.86） 粥样硬化斑块 粥样斑块 4148（49.14） 溃疡斑块 195（2.31） 其它病理改变 壁内血肿 62（0.73） 附壁血栓 6（0.07） 动脉炎 8（0.09） 动脉蹼 3（0.04）
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表 5 多重影像评估的动脉管腔病理改变[n（%）]
Table 5. The pathological changes of arterial lumen assessed by multiple images [n（%）]
动脉系统 病例数 前循环 颈总动脉狭窄闭塞 736（8.7） 颈内动脉狭窄闭塞 2437（28.9） 大脑中动脉狭窄闭塞 3313（39.2） 大脑前动脉狭窄闭塞 751（8.9） 后循环 椎动脉狭窄闭塞 2155（25.5） 基底动脉狭窄闭塞 1836（21.7） 大脑后动脉狭窄闭塞 2347（27.8） 椎动脉纤细 1186（14.0） 颅内交通支开放 1053（12.4）
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表 6 DWI评估的急性缺血性脑卒中责任血管[n（%）]
Table 6. The responsible vessels of acute ischemic stroke assessed by DWI [n（%）]
责任血管 病例数 前循环 4924（58.33） 颈内动脉 553（6.56） 大脑前动脉 87（1.03） 大脑中动脉 4284（41.67） 后循环 2825（33.47） 椎动脉 732（8.67） 基底动脉 1567（18.56） 大脑后动脉 526（6.23） 前循环与后循环 692（8.20） 合计 8441（100）
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表 7 急性缺血性脑卒中发生机制[n（%）]
Table 7. The pathogenesis of acute ischemic stroke [n（%）]
发病机制 病例数 动脉到动脉栓塞 3002（35.57） 局灶穿枝动脉闭塞 2601（30.81） 低灌注栓子清除障碍 2498（29.59） 心源性栓塞 340（4.02） 合计 8441（100）
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