北京市儿童医院10年儿童脑卒中疾病谱回顾性分析

目的 回顾性分析脑卒中患儿的疾病谱病因学及危险因素分布特征。方法 采用回顾性病历调查方法，总结分析1996年1月至2006年6月首都医科大学附属北京儿童医院251例脑卒中患儿的临床资料。结果 脑卒中患儿发病平均年龄为（3.0±3.8）岁；男性156例，女性95例。动脉缺血性脑卒中（AIS）占62.5%（157/251），出血性脑卒中（HS）占37.5%（94/251）。两者均无明显季节分布差异，但郊区（县）发病较城区更为严重。特发性脑卒中（IS）51例（32.5%，51/157）居于AIS病例各亚类首位。已明确病因的AIS病例中以感染（12.1％，19/157）、烟雾病（12.1％，19/157）、头部外伤（10.8％，17/157）和营养性缺铁性贫血（7.6％，12/157）最常见。惊厥（20.4%，25/157）和言语困难（15.9%，25/157）则是IS患儿较常见症状。颅内出血发生部位主要为大脑内（41.5%，39/94）和蛛网膜下隙（13.8%，13/94）。维生素K缺乏（76.6%，72/94）则是导致小婴儿颅内出血的重要诱发因素。 .结论 IS是儿童AIS的最常见类型；维生素K缺乏仍是我国引起小婴儿颅内出血的最常见诱发因素。

Retrospective analysis of the disease spectrum of stroke in childhood

Objective To describe the disease spectrum of stroke in childhood, especially to analyze the characteristics of potential etiologies and risk factors of children stroke. Methods This study retrospectively reviewed the records of nearly all 1 month to 16 years old children who were admitted to Beijing Children′s Hospital from Jan 1996 to Jun 2006 (many of these cases were inpatients of Neurology Department). Patients were eligible for enrollment in this study if they fulfilled the following conditions:①diagnosed as arterial ischemic stroke (AIS) or hemorrhagic stroke (HS) ;② an acute focal neurological deficit of sudden onset that persisted more than 24 hours;③neuroimaging evidence of cerebral infarction or intracranial hemorrhage. Patients with transient ischemic attack (TIA) and those who had prenatal and neonatal stroke and/or had venous infarction were excluded. As a result, a total of 251 children with the diagnosis of stroke were included in this study to analyze the disease spectrum of childhood stroke. Results 156 boys (62.2%) and 95 girls (37.8%) were included in the analysis. Age ranged from 0.33 to 16.00 years with a mean of (4.37±3.98) years and a median of 2.67 years. Most patients came from north China, and children from the countryside were more than urban residents. AIS was diagnosed in 157 patients (62.5%) and HS in 94 (37.5%). No significant difference in season distribution was found between both groups. In the AIS group, idiopathic stroke (32.5%) was the most common subtype (among which 9.8% had transient infection before stroke attack), hematological stroke accounted for 10.8% and cardiac stroke was diagnosed in 8.9% of cases. Male patients (n=92; 58.6%) were more than female patients (n=65; 41.4%) in AIS group, no differences was found in gender or age among AIS subtypes (P＞0.05 by χ2 test). Hyperglycemia (10.2%) and hyperlipidemia (9.6%) were the most common possible risk factors for the AIS group, whereas seizure (20.4%) and dysphasia (15.9%) were the most common clinical manifestation in our AIS cohort. No difference were found in risk factors or clinical manifestation among different subtype(P＞0.05). Moyamoya disease (57.6%) was the major etiology in vascular or arteriopathic stroke, followed by idiopathic vasculitis (21.2%) and cerebrovascular malformation (12.1%). In cardiac stroke, congenital heart disease and arrhythmias accounted for 35.7% of the cases while acquired heart disease accounted for only 28.6% of the cases. For hematologic stroke, nutritional iron deficiency anemia (70.6%) was the major contributive factor, while only one patient had positive anticardiolipin antibody and one patient had a positive D-dimer test. In the group of other determined etiology, the two most common etiologies were infection (n=19, 45.2%) and head injury (40.5%). 31.6% of these patients had viral encephalitis, and 21.1% had varicella zoster virus infection. Of 94 patients with HS, 39 (41.5%) had intracerebral hemorrhage, 38 (40.4%) suffered multiple loci hemorrhage, 13 patients had subarachnoid hemorrhage, 6 patients had arteriovenous malformation (6.4%), 4 patients had subdural hemorrhage, and in five patients no etiology was found. Vitamin K deficiency was a major risk factor in 72 of 94 HS (76.6%).Most of these vitamin K deficiency cases came from rural area (56 of 72, 77.8%) and occurred in relatively younger infants ［average age (1.54±0.55)months］. Conclusions Ischemic stroke in children is much more common than haemorrhagic stroke. Many cases are idiopathic. Genetic predisposition combined with transient infection may be involved in stroke development during childhood. Vitamin K deficiency is a major risk factor in young infants with haemorrhagic stroke.