不明原因栓塞性卒中的临床研究

摘要/Abstract

摘要：

目的研究不明原因栓塞性卒中（embolic stroke of undetermined source，ESUS）住院患者的一般情况、危险因素及治疗情况。方法检索2003年1月至2014年12月在北京安贞医院神经内科住院的急性缺血性卒中患者，筛选其中符合ESUS诊断标准的为ESUS组，其他卒中亚型为对照组，比较两组间一般情况、危险因素及治疗情况。结果共检出初发急性缺血性卒中1296例，筛选完成诊断ESUS必须检查项目患者200例，其中ESUS占 46.5%（93/200例），大动脉硬化性卒中26%（52/200例），心源性卒中25%（50/200例），腔隙性脑梗死2.5%（5/200例），隐源性卒中（cryptogenic stroke，CS）0例；ESUS患者卒中危险因素与对照组比较基本一致；ESUS患者中94.6%（88/93例）在住院期间及出院后二级预防应用抗血小板治疗，而5.4% 患者（5/93例）因梗死后渗血未应用抗栓治疗，所有入选ESUS的患者均未使用华法林或新型口服抗凝剂抗凝治疗。结论 ESUS作为新的卒中亚型在临床工作中并不少见，临床应完善诊断ESUS所需的检查项目，提高其诊断率，进一步细化卒中亚型，从而提供更有针对性的治疗。

文章导读： 本文应用最近提出的不明原因栓塞性卒中（ESUS）诊断标准对该人群进行了回顾性分析，以期帮助大家更科学地了解ESUS的诊断及治疗。

关键词: 不明原因栓塞性卒中; 诊断标准; 筛查方法

Abstract:

Objective To investigate the general information, risk factors and treatments of in-patients with embolic stroke of undetermined source (ESUS) population. Methods Retrospective review of hospital records of patients admitted in Dept. of Neurology of Beijing Anzhen Hospital between Jan 2003 and Dec 2014 was made. Patients meeting the criteria for ESUS were enlisted into test group, and other subtypes of stroke were enlisted into control group. The general information, risk factors and treatments were compared between two groups. Results In total, 1296 patients with first acute ischemic stroke were retrieved. Two hundred patients of them were enrolled for completing the examination of ESUS diagnosis, among which 46.5% (93/200) patients met the criteria for ESUS. Other subtypes included large-artery atherosclerotic 26% (52/200), cardioembolism 25% (50/200), lacunar 2.5% (5/200) and cryptogenic stroke 0. The distribution of stroke risk factors in ESUS patients followed the same pattern as in the general stroke population. At hospital discharge, 94.6% (88/93) received antiplatelet therapy, and 5.4% (5/93) received no antithrombotic therapy because of errhysis after infarction. Neither warfarin nor new oral anticoagulant was used upon patients with ESUS. Conclusion Ischemic stroke patients meeting criteria for ESUS are not uncommon. Clinicians should complete the examination of ESUS diagnosis, increasing its diagnosis rate, further refine the stroke subtype, thus providing more targeted treatment.

Key words: Embolic stroke of undetermined source; Diagnostic criteria; Screening method

黄维，毕齐. 不明原因栓塞性卒中的临床研究[J]. 中国卒中杂志, 2016, 11(02): 115-119.

HUANG Wei, BI Qi. Clinical Study on Embolic Stroke of Undetermined Source[J]. Chinese Journal of Stroke, 2016, 11(02): 115-119.

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