缺血性脑卒中CISS分型与OCSP分型的临床应用研究

发布时间：2018-02-01 09:16

本文关键词： 缺血性脑卒中中国缺血性卒中亚型 OCSP分型预后　出处：《兰州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过对急性缺血性脑卒中住院患者进行中国缺血性卒中亚型(Chinese Ischemic Stroke Subclassification, CISS)分型和英国牛津郡社区卒中计划(Oxfordshire Community Stroke Project, OCSP)分型,了解各亚型的构成情况、两种分型方法的特性以及两者间的关系,并在此基础上探讨CISS分型联合OCSP分型在评估患者病情和预后方面的临床应用价值。方法：连续收集兰州大学第二医院神经内科急性缺血性脑卒中住院患者300例,按照CISS和OCSP标准分别将患者分为具体亚型,观察并比较住院患者中两种分型系统各亚型的分布情况。应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评定患者入院及出院时神经功能状态,以出院时神经功能好转率评价其临床短期预后,分析CISS各亚型和OCSP各亚型患者的病情和预后情况。结果：1.CISS分型中各亚型的构成由高到低依次为：穿支动脉疾病127例(42.3%),大动脉粥样硬化98例(32.7%),病因不确定51例(17.0%),心源性卒中19例(6.3%),其他病因5例(1.7%)。5种亚型中穿支动脉疾病所占比例最高(x2=178.67,P0.001)。OCSP分型中各亚型的构成由高到低依次为：腔隙性梗死138例(46.0%),部分前循环梗死91例(30.3%),完全前循环梗死40例(13.3%),后循环梗死31例(10.3%)。4种亚型中腔隙性梗死所占比例最高(X2=98.48,P0.001)。 2.两种分型方法的相关性研究结果如下：CISS分型中,大动脉粥样硬化患者临床多表现为部分前循环梗死(46.9%,x2=26.49,P0.001),穿支动脉疾病患者临床多表现为腔隙性梗死(80.3%, x2=211.68, P0.001). OCSP分型中,完全前循环梗死患者的主要病因为大动脉粥样硬化(55.0%,x2=33.25,P0.001),其次为心源性卒中(20.0%)；部分前循环梗死及后循环梗死患者的主要病因均为动脉粥样硬化(50.5%,48.4%; x2=63.78, x2=19.81; P0.001, P=0.001);腔隙性梗死患者的主要病因为穿支动脉疾病(73.9%,X2=181.71,P0.001)。 3.不同亚型患者的病情和预后情况如下：CISS分型中,穿支动脉疾病患者入院时NIHSS评分最低(4.67±1.77)分、病情最轻,出院时神经功能好转率最高(50+13)%、预后最好；心源性卒中患者入院时NIHSS评分最高(14.634±4.63)分、病情最重,出院时神经功能好转率最低(25+9)%、预后最差。OCSP分型中,腔隙性梗死患者入院时NIHSS评分最低(4.71±1.67)分、病情最轻,出院时神经功能好转率最高(50士13)%、预后最好；完全前循环梗死患者入院时NIHSS评分最高(12.28±4.39)分、病情最重,出院时神经功能好转率最低(24±26)%、预后最差。 4. CISS分型与OCSP分型联合应用,对急性缺血性脑卒中患者病情和预后的评估结果如下：临床症状表现为腔隙性梗死同时病因为穿支动脉疾病的患者一般病情较轻、预后较好；临床症状表现为完全前循环梗死同时病因为心源性栓塞的患者多数病情重、预后差。结论：1OCSP分型以患者的临床表现为诊断依据,可在急性期未完善相关检查的情况下指导缺血性脑卒中患者的早期治疗。 2. CISS分型既有病因诊断又有发病机制诊断,可为脑梗死患者的病因治疗和二级预防提供更准确的参考意见。 3. CISS分型与OCSP分型之间有一定的相关性。 4. CISS分型和OCSP分型均能有效评估缺血性脑卒中患者的病情和预后。 5. CISS分型和OCSP分型联合应用可对脑梗死患者的病情和预后做出综合性的评价,为缺血性脑卒中的有效防治提供更准确的参考依据。
[Abstract]:Objective : To study the clinical application value of CISS classification in evaluating the condition and prognosis of patients with acute ischemic stroke in Chinese Stroke Stroke Subclassification ( CISS ) typing and the British Oxford Community Stroke Project . Methods : 300 patients with acute ischemic stroke in the Second Affiliated Hospital of Lanzhou University were continuously collected , and the patients were divided into specific subtypes according to CISS and the criteria of the criteria . The distribution of the subtypes of the two typing systems was observed and compared . The clinical short - term prognosis was evaluated by using the National Institutes of Health Stroke Scale ( NIHSS ) . The clinical short - term prognosis of patients with CISS and the patients with different subtypes were analyzed . Results : 1 . The composition of each sub - subtype in CISS typing was from high to low in order : 127 cases ( 42.3 % ) through branch artery disease , 98 cases of atherosclerosis ( 32.7 % ) , 51 cases ( 17.0 % ) , 19 cases of cardiac stroke ( 6.3 % ) , 5 cases of other causes ( 1.7 % ) , and the highest proportion of penetrating branch artery disease among 5 subtypes ( x2 = 178.67 , P0.001 ) . There were 138 cases of lacunar infarction ( 46.0 % ) , 91 cases of partial anterior circulation infarction ( 30 . 3 % ) , 40 cases of complete anterior circulation infarction ( 13.3 % ) , 31 cases of posterior circulation infarction ( 10.3 % ) , and the highest proportion of lacunar infarction ( X2 = 98.48 , P0.001 ) . 2 . The results of the correlation between the two typing methods were as follows : In CISS classification , the clinical manifestations of patients with atherosclerosis were partial anterior circulation infarction ( 46.9 % , x2 = 26.49 , P0.001 ) , and the clinical manifestations of transarterial disease were lacunar infarction ( 80.3 % , x2 = 211.68 , P0.001 ) . The main causes of the patients with complete anterior circulation infarction were atherosclerosis ( 55.0 % , x2 = 33.25 , P0.001 ) , followed by cardiac stroke ( 20.0 % ) ; the major causes of partial anterior circulation infarction and post - cycle infarction were atherosclerosis ( 50.5 % , 48.4 % ; x2 = 63.78 , x2 = 19.81 ; P0.001 , P = 0.001 ) ; the primary disease in lacunar infarction was due to transarterial disease ( 73.9 % , X2 = 181.71 , P0.001 ) . 3 . The condition and prognosis of patients with different subtypes were as follows : In CISS classification , NIHSS score was the lowest ( 4.67 卤 1.77 ) at admission , the highest ( 14.634 卤 4.63 ) % , and the worst prognosis . The NIHSS score was the highest ( 12.28 卤 4.39 ) at discharge and the worst prognosis . At discharge , NIHSS score was the highest ( 12.28 卤 4.39 ) , the lowest was ( 24 卤 26 ) % , and the prognosis was worst . 4 . The combined application of CISS typing and ocsp typing in patients with acute ischemic stroke is as follows : the clinical symptoms appear as lacunar infarction while the patients with transarterial disease are generally mild and have good prognosis ; the clinical symptoms manifest as complete anterior circulation infarction while the majority of patients with cardiac embolism are serious and the prognosis is poor . Conclusion : The clinical manifestations of the patients can be diagnosed according to the clinical manifestations of the patients , and the early treatment of ischemic stroke patients can be guided without complete correlation examination in the acute phase . 2 . CISS typing has both etiological diagnosis and pathogenesis diagnosis , which can provide more accurate reference for the etiological treatment and secondary prevention of cerebral infarction patients . 3 . There is a certain correlation between CISS typing and classification . 4 . Both the CISS classification and the classification can effectively assess the condition and prognosis of ischemic stroke patients . 5 . The combined application of CISS typing and the classification can provide a more accurate reference for the effective prevention and treatment of ischemic stroke .

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】