中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (4): 285-290.DOI: 10.19538/j.ek2023040610

• 论著 • 上一篇    下一篇

不同年龄段儿童动脉缺血性脑卒中病因分析

  

  1. 国家儿童医学中心  首都医科大学附属北京儿童医院神经内科，北京  100045
  • 出版日期:2023-04-06 发布日期:2023-05-15
  • 通讯作者: 任晓暾，电子信箱：rxt1997@126.com

Etiological analysis of arterial ischemic stroke in children of different age groups

  1. Department of Neurology，Beijing Children’s Hospital，Capital Medical University，National Center for Children’s Health，Beijing  100045，China
  • Online:2023-04-06 Published:2023-05-15

摘要： 目的　探讨不同年龄段儿童动脉缺血性脑卒中（AIS）的病因。方法　回顾性分析首都医科大学附属北京儿童医院神经内科病房2016年1月至2020年12月收治的AIS患儿资料，根据2019年美国心脏协会和美国卒中协会儿童脑卒中的管理指南将AIS病因分为心源性、易栓症、脑动脉病、其他、病因不详5大类。根据年龄分为婴幼儿（>28 d至<3岁）、学龄（前）儿童（3～<10岁）和青少年（10～<18岁）。分析不同病因患儿的临床特点。结果　共纳入129例AIS患儿。脑动脉病是首要病因，共47例（36.43%），最常见的亚型为局灶脑动脉病（FCA，15例）和Moyamoya病（17例）。婴幼儿AIS共51例（39.53%），外伤后基底节脑梗死是首要病因（24/51，47.06%），这部分患儿中21例有基底节钙化。学龄（前）儿童AIS共54例（41.86%），青少年AIS共24例（18.60%），两者均以脑动脉病为首要病因。学龄（前）儿童AIS中存在11例病因不详的患儿，均为男性，影像学椎基底动脉供血区有多个梗死灶，不能除外椎动脉夹层，但均未行颈部CTA或MRA检查。青少年AIS中2例患儿经基因检查明确诊断为腺苷酸脱氨酶2缺乏症。结论　不同年龄段儿童AIS病因存在差异，婴幼儿以外伤后基底节脑梗死最为常见，学龄（前）儿童和青少年以脑动脉病最为常见。FCA和Moyamoya病是脑动脉病中最常见的亚型。

关键词: 动脉缺血性脑卒中, 儿童, 年龄, 病因

Abstract: The clinical data of children with AIS admitted to Neurological Department of Beijing Children's Hospital in recent 5 years were retrospectively analyzed.According to management guidelines of American Heart Association/American Stroke Association，the etiology of AIS was classified into five categories：cardiac，thrombophilia，arteriopathy，other and unknown etiology. According to age，they were classified as infants（>28 days and<3 years old），（pre）school-age children（≥3 years old and <10 years old）and adolescents（≥10 years old and <18 years old）. The clinical characteristics of different etiology was analyzed. Results    A total of 129 children with AIS were included.Arteriopathy was the primary cause of AIS in children，47 cases（36.43%）.The most common subtypes were focal cerebral arteriopathy（FCA，15 cases）and Moyamoya disease（17 cases）.There were 51 cases of AIS in infants（39.53%）.Basal ganglia infarction after trauma was the primary cause（24/51，47.06%）.Basal ganglia calcification was found in 21 of these children. Totally 54 cases（41.86%）of AIS were found in（pre）school-age children and 24 cases（18.60%）in adolescents.Arteriopathy was the primary cause for both groups.In（pre）school-age children with AIS，there were 11 children with unknown etiology，all of whom were male. Cerebral MRI indicated spotted and flaky lesions in area supplied by vertebrobasilar artery.The diagnosis of vertebral artery dissection could not be ruled out. However，no neck MRA or CTA examination was performed. Two children in adolescent group were diagnosed with deficiency of adenosine deaminase 2 by gene detectiion. Conclusion    There are differences in etiology of AIS in children of different age groups. Basal ganglia infarction after trauma is the primary cause in infants. Arteriopathy is the primary cause in（pre）school-age children and adolescents.FCA and Moyamoya disease are the most common subtypes of arteriopathy.

Key words: arterial ischemic stroke, child, age, etiology