轻型卒中的病因分型和相关危险因素分析

目的分析中国广东地区不同病因轻型卒中患者的相关危险因素。方法发病3 d内的轻型卒中(minor stroke,MS)患者,根据CISS分型分为大动脉粥样硬化型(large artery atherosclerosis,LAA)、心源性卒中(cardiogenic stroke,CS)、穿支动脉病(penetrating artery disease,PAD)、其他病因(other etiology,OE)及病因未明(undetermined etiology,UE)五个亚组,分析它们之间危险因素的差异。结果共纳入轻型卒中患者303例,在常见危险因素中,轻型卒中患者患有高血压、高脂血症及糖尿病所占比例相对最多,分别为72.3%、58.3%及39.9%;而不同病因中,LAA及PAD所占比例最高(分别为41.9%、50.8%),且两组患者对比血甘油三酯(TG)(1.765±1.18)mg/L vs.(2.19±1.84)mg/L,P=0.03]、载脂蛋白B(Apo B)[(0.95±0.29)mg/L vs.(1.11±0.46)mg/L,P=0.009]、C反应蛋白(CRP)[(6.63±11.30)mg/L vs.(3.42±5.02)mg/L,P=0.042]及Apo B/Apo A1[(0.754±0.25)mg/L vs.(0.875±0.49)mg/L,P=0.019]的差异均有统计学意义。结论高血压、高脂血症及糖尿病是轻型卒中最主要的危险因素;广东地区轻型卒中发病机制最常见为PAD,其次为LAA;对轻型卒中患者进行TG、Apo B、Apo B/Apo A1、CRP等检测,也许能协助进行CISS分型。

The analysis of risk factors and subtypes with CISS classification of minor stroke

Objective To investigate the features of risk factors of minor stroke with CISS classification in Guangdong Province. Methods We retrospectively investigated the patients admitted within 3 days of the occurrence of a minor stroke, and were classified by CISS criteria as large artery atherosclerosis (LAA), cardiogenic stroke (CS), penetrating artery disease (PAD), other etiology (OE), undetermined etiology (UE). Results In this study, 303 pa-tients met the inclusion criteria of minor stroke. The highest percentage of the risk factors included hypertension (72.3%), hyperlipidemia (58.3%), and diabetes mellitus (39.9%). Among different subtypes, 41.9% were diagnosed with LAA, and 50.8% with PAD. Plasma triglyceride (TG)(1.765 ±1.18)mg/L vs.(2.19 ±1.84)mg/L,P=0.03], apolipoproteinsB (ApoB) [(0.95±0.29)mg/L vs.(1.11±0.46)mg/L,P=0.009]C-reactive protein (CRP) [(6.63±11.30) mg/L vs.(3.42 ±5.02)mg/L,P=0.042] and ApoB/ApoA1 ratio [(0.754 ±0.25)mg/L vs.(0.875 ±0.49)mg/L,P=0.019], differed significantly between group LAA and PAD. Conclusion Hypertension, hyperlipidemia and diabetes mellitus are the major risk factors of minor stroke. The most common subtypes of the minor stroke patients in Guangdong Province are LAA and PAD, and detecting their TG, apoB, CRP level and apoB/apoA1 ratio might help subclassify minor stroke according to CISS.