Abstract: Objective To investigate the distribution of different acute ischemic stroke subtypes according to the China ischemic stroke subclassification(CISS) criteria and its related risk factors.Methods One hundred and seventy patients with acute ischemic stroke in our hospital were collected from March 2011 through July 2011. The clinical characteristic and examination results of each patient including blood test, ultrasound and brain computed tomography/magnetic resonance imaging were collected. All patients were subclassified according to the CISS criteria. Retrospective analysis of the proportion of each subtype of acute ischemic stroke in in-patient was taken. The presentation of common risk factors(hypertension, diabetes mellitus, lipid disorders, heart diseases and smoke history) in each group were measured and compared with others.Results Among the 170 patients studied, the etiology subtypes included 128 cases(75.3%) of large artery atherosclerosis(LAA), 25 cases(14.7%) of cardiogenic stroke(CS), 14 cases(8.2%) of penetrating artery disease(PAD), 1 in other etiologies, and 2 in undetermined etiology. Theunderlying mechanism subtypes included 87 patients of parent artery(plaque or thrombus) occluding penetrating artery, 24 cases of artery-to-artery embolism, 17 cases of hypoperfusion/impaired emboli clearance and 0 case of multiple mechanism. Hypertension was the most common condition(81.1%) but no statistically difference was found among the CISS groups. Lipid metabolic disorder and smoke history were found in 75(58.6%) and 61(47.7%) of LAA group, which is statistically higher than those of the other two groups(P<0.05). While the frequency of patients with heart diseases(100%) in CS group was statistically higher than the other groups(P<0.01), patients with diabetes mellitus(57.1%) was significantly more common in PAD(P<0.05). No further significantly difference was found among different subtypes regarding the related risk factors.Conclusion LAA is the most common cause of ischemic stroke while parent artery occluding penetrating artery play the main role in pathogenesis of acute infarction. Smoking and lipid metabolic disorder were more correlated to LAA, and diabetes mellitus was suggested to be the main related risk factor of PAD.

Key words: Brain infarction; China ischemic stroke subclassification; Risk factors

摘要： 目的 按照中国缺血性卒中分型（China Ischemic Stroke Subclassification，CISS）标准，观察各类型脑梗死在住院患者中的分布，探讨常见危险因素在各类型脑梗死中分布的差异性。方法 2011年3月至2011年7月住我院急性脑梗死患者完成超声、影像学及相关实验室检查，按照CISS进行病因和病理机制分型，回顾性分析住院患者不同病因脑梗死的比例，分析高血压、糖尿病、脂代谢紊乱、心脏病、吸烟等常见危险因素在不同脑梗死类型中分布差异性。结果 入组病例170例。经CISS病因分型，大动脉粥样硬化性脑梗死128例（75.3%），心源性脑梗死25例（14.7%），穿支动脉病变14例（8.2%），其他原因1例（0.6%），不明原因2例（1.2%）。大动脉粥样硬化性脑梗死病理机制分型：载体动脉阻塞穿支87例、动脉-动脉栓塞24例、低灌注/栓子清除障碍17例、多种机制0例。在病因分型中各组患者合并高血压的比例最高，平均为81.1%，但在各组之间分布差异无统计学意义；大动脉粥样硬化性脑梗死患者合并脂代谢紊乱比例高于心源性卒中组（58.6% vs 32.0%，P=0.015)和穿支动脉疾病组（58.6% vs 28.6%，P=0.032），后二者比较差异无统计学意义（32.0% vs 28.6%，P=1.000）；另外，大动脉粥样硬化性脑梗死患者吸烟史的比例明显高于心源性卒中组（47.7% vs 20.0%，P=0.011）及其他各组；心源性脑梗死合并心脏病比例高于大动脉粥样硬化性脑梗死组（100% vs 32.0%，P=0.000）及其他各组；穿支动脉病变患者合并糖尿病比例显著高于心源性卒中组（57.1% vs 12.0%，P=0.007），但与大动脉粥样硬化性脑梗死组相比差异无统计学意义（57.1% vs 29.7%，P=0.067），而后二者比较差异也无统计学意义（P=0.068）。而上述危险因素在大动脉粥样硬化性脑梗死病理机制分型各亚组中的分布差异无统计学意义。结论 CISS分型中大动脉粥样硬化性脑梗死是急性脑梗死最常见的病因类型，其中以载体动脉阻塞穿支为最常见的病理机制。脂代谢紊乱、吸烟与大动脉粥样硬化性脑梗死关系密切，而糖代谢异常与穿支动脉病变关系密切。

关键词: 脑梗死; 中国缺血性卒中分型; 危险因素