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背景:目前WHO的国际疾病分类和中国通用的脑血管疾病分类以及国外常用的TOAST分类法都是基于病理生理的分类方法,北京等地区尚未见到有关人脑梗死影像学分型的报道。目的:回顾分析北京市急性脑梗死磁共振显示的亚型分布情况,使北京市急性缺血性卒中患者得到更准确的病因学和个体化治疗。设计:以患者为观察对象,回顾性病例分析。单位:解放军北京军区总医院神经内科。对象:实验于2004-01/12在解放军北京军区总医院、北京中日友好医院、北京朝阳医院、解放军海军总医院和北京积水潭医院完成。选取因缺血性卒中在各医院住院治疗的患者602例,男352例,女250例_平均年龄(65.6±10.2)岁。方法:回顾分析北京市东城、西城、朝阳、海淀上述4个区5家医院2004年接诊的602例急性缺血性脑卒中患者,内容包括病史特征、影像学检查和实验室检查。根据患者头颅磁共振成像结果和症状相对应的最大梗死面积,将患者进行脑卒中分型。大梗死:超过1个脑叶,5.0cm以上;中梗死:<1个脑叶,3.1～5.0cm;小梗死:1.6～3.0cm;腔隙梗死:<1.5cm。主要观察指标:各组患者MRI分型构成比。结果:602例缺血性卒中患者全部纳入结果分析。北京市5家医院急性脑梗死患者中腔隙性梗死者为280例,其亚型构成为46.5%;小梗死者229例,亚型构成为38.1%;中梗死者为57例,亚型构成为9.4%;大梗死者为36例,亚型构成为6%。腔隙性梗死与其余各型相比差异有显著性(P<0.001)。结论:北京市急性脑梗死的分布以腔隙性梗死为多发,提示小动脉病变是北京市缺血性卒中的最主要病理改变,可用于急性缺血性脑卒中的早期分型、指导治疗和评估预后。
Background: At present, the international classification of WHO and the general classification of cerebrovascular diseases in China and the TOAST classification commonly used in foreign countries are based on pathophysiological classification methods. No reports on the imaging type of human cerebral infarction have been seen in Beijing and other regions. OBJECTIVE: To retrospectively analyze the distribution of subtypes showed by MRI in Beijing and to get more accurate etiology and individualized treatment for acute ischemic stroke in Beijing. Design: Patient observation, retrospective case analysis. SETTING: Department of Neurology, Beijing Military Region General Hospital. PARTICIPANTS: The experiment was performed at PLA General Hospital Beijing Military Region, Beijing Sino-Japanese Friendship Hospital, Beijing Chaoyang Hospital, People’s Liberation Army Navy General Hospital and Beijing Jishuitan Hospital from January to December in 2004. A total of 602 patients were enrolled in hospitalizations for ischemic stroke, including 352 males and 250 females with a mean age of (65.6 ± 10.2) years. Methods: A retrospective analysis of 602 acute ischemic stroke patients admitted to four hospitals in four districts of Beijing, including Dongcheng, Xicheng, Chaoyang and Haidian in 2004, including the history, imaging and laboratory tests. Patients were classified according to their stroke with the maximum infarct size corresponding to the patient’s head MRI and symptoms. Large infarction: more than one lobe, 5.0cm above; infarction: <1 lobe, 3.1 ~ 5.0cm; small infarction: 1.6 ~ 3.0cm; lacunar infarction: <1.5cm. MAIN OUTCOME MEASURES: MRI classification ratio in each group. Results: All 602 patients with ischemic stroke were included in the result analysis. There were 280 cases of lacunar infarction in 5 hospitals in Beijing and 46.5% of them were subclavian infarction patients. 229 cases of small infarcts were subtypes of 38.1%, 57 cases of middle infarct were subtypes 9.4%; 36 cases of large infarcts, subtype constitutes 6%. Lacunar infarction compared with the other types of differences was significant (P <0.001). Conclusion: The distribution of acute cerebral infarction in Beijing is mainly caused by lacunar infarction. It suggests that arterioles lesion is the most important pathological change of ischemic stroke in Beijing. It can be used in the early stage of acute ischemic stroke, guiding treatment and Evaluate the prognosis.