北京市5家医院602例急性脑梗死患者MRI分型

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。

MRI classification of 602 cases of acute cerebral infarction from 5 hospitals in Beijing

BACKGROUND: At present, international classification of diseases by WHO, cerebrovascular disease classification used in China and TOAST classification used abroad are all based on patho-physiology. There is no report about human cerebral infarction by magnetic imaging types in Beijing and other areas.OBJECTIVE: To analyze retrospectively the subtype distribution of acute cerebral infarction of patients in Beijing by magnetic resonance imaging in order to make Beijing patients with acute ischemic stroke receive more exact and individualized treatment.DESIGN: Retrospective case study.SETTING: Department of Neurology, General Hospital of Beijing Military Area Command of Chinese PLA.PARTICIPANTS: The study was carried out in General Hospital of Beijing Military Area Command of Chinese PLA, Beijing Sino-Japan Friendship Hospital, Beijing Chaoyang Hospital, Beijing Naval General Hospital and Beijing Jishuitan Hospital between January and December 2004. Totally 602 inpatients with ischemic stroke who received treatment in each hospital were recruited. They were 352 male and 250 female with average age of (65.6±10.2) years.METHODS: The 602 patients with acute ischemic cerebral stroke who received the treatment in the 5 hospitals from Dongcheng, Xicheng,Chaoyang and Haidian districts in Beijing were recruited in the study. According to results of magnetic resonance imaging of brain, the maximal infarction area were determined. The patients were classified as: large infarction: over 1 lobe of brain, ＞ 5.0 cm in diameter; moderate infarction: less than 1 lobe of brain, 3.1-5.0 cm; small infarction: 1.6-3.0 cm; lacunar infarction, ＜ 1.5 cm.MAIN OUTCOME MEASURES: Constitution ratio of MRI classification of patients in each groupRESULTS: Totally 602 patients with ischemic stroke participanted in final result analysis. Among the patients with acute cerebral infarction of 5 hospitals in Beijing, 280 (46.5%) suffered from lacunar infarction, 299(38.1%) from small infarction, 57 (9.4%) from moderate infarction, and 36 (6%) from large infarction. There were significant differences between lacunar infarction and other types (P ＜ 0.01).CONCLUSION: Acute cerebral infarction of patients of Beijing mostly occurs in the type of lacunar infarction. It suggests that small arterial diseases are the major disease type of ischemic stroke in Beijing. This MRI classfication can be used for early classification, treatment guidance, evaluation and prognosis of acute ischemic cerebral stroke.