儿童动脉缺血性脑卒中临床特征分析：一项单中心回顾性研究

doi:10.12372/jcp.2025.24e1081

摘要/Abstract

摘要：

目的探讨儿童动脉缺血性脑卒中（PAIS）分类方法、影像检查方法及治疗经验。方法收集2016年1月至2024年7月收治的 PAIS患儿临床资料，对其临床表现、影像学检查、治疗及转归进行回顾性分析并重新按COIST病因进行分类。结果共纳入27例PAIS患儿，男11例，女16例，年龄从5月龄到13岁。炎症性（I）病因有11例（40.7%），血管结构异常（S）病因有4例（14.8%），其他可确定的病因（创伤性脑梗死）（O）有6例（22.2%），病因不明6例（22.2%），易栓症（T）及心脏疾病（C）未收治。最常出现的症状是肌无力，头晕、头痛及意识水平下降。根据影像学表现大脑中动脉受累最常见，共12例（44.4%）。27例患儿中15例（55.5%）接受抗凝治疗，14例（51.8%）接受免疫治疗，2例（7.4%）行溶栓治疗。结论 COIST分型病因导向明确，在病因分析和治疗指导方面具有重要临床价值，但需进一步优化以适应更广泛的临床应用场景。

关键词: 动脉缺血性脑卒中, 病因分类, 神经影像学, 儿童

Abstract:

Objective To explore the classification methods, imaging examination methods, and treatment experiences of pediatric arterial ischemic stroke (PAIS). Methods Clinical data of PAIS patients admitted from January 2016 to July 2024 were collected. Their clinical manifestations, imaging examinations, treatments, and outcomes were retrospectively analyzed, and reclassified according to the COIST etiological classification. Results A total of 27 PAIS patients were enrolled, including 11 males and 16 females, aged from 5 months to 13 years. The etiologies identified were as follows: inflammatory (I) in 11 cases (40.7%), vascular structural abnormalities (S) in 4 cases (14.8%), other definite causes (traumatic infarction) (O) in 6 cases (22.2%), and undetermined causes in 6 cases (22.2%). Arteriopathy (T) and cardiac diseases (C) were not identified in this cohort. The most common symptoms were muscle weakness, dizziness, headache, and decreased consciousness. Imaging findings revealed that the middle cerebral artery (MCA) was the most frequently affected, occurring in 12 (44.4%) cases. Among the 27 patients, 15 (55.5%) received anticoagulant therapy, 14 (51.8%) underwent immunotherapy, and 2 (7.4%) underwent thrombolytic treatment. Conclusion The COIST etiological classification provides clear guidance and holds significant clinical value in etiological analysis and treatment direction. However, further optimization is needed to adapt to broader clinical applications.

Key words: arterial ischemic stroke, etiological classification, neuroimaging, child

中图分类号:

谢利林, 许锦平, 姚拥华. 儿童动脉缺血性脑卒中临床特征分析：一项单中心回顾性研究[J]. 临床儿科杂志, 2025, 43(6): 432-437.

XIE Lilin, XU Jinping, YAO Yonghua. Pediatric arterial ischemic stroke: a single-center retrospective study[J]. Journal of Clinical Pediatrics, 2025, 43(6): 432-437.

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参考文献 27

[1]	Schoenberg BS, Mellinger JF, Schoenberg DG. Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival[J]. Neurology, 1978, 28(8): 763-768. doi: 10.1212/wnl.28.8.763 pmid: 567292
[2]	Sun LR, Lynch JK. Advances in the diagnosis and treatment of pediatric arterial ischemic stroke[J]. Neurotherapeutics, 2023, 20(3): 633-654. doi: 10.1007/s13311-023-01373-5 pmid: 37072548
[3]	Felling RJ, Sun LR, Maxwell EC, et al. Pediatric arterial ischemic stroke: epidemiology, risk factors, and management[J]. Blood Cells Mol Dis, 2017, 67: 23-33.
[4]	中华医学会儿科学分会神经学组. 儿童动脉缺血性脑卒中诊疗专家共识[J]. 中华儿科杂志, 2022, 60(12):1248-1252.
	Subspecialty Group of Neurology Diseases, the Society of Pediatrics, Chinese Medical Association. Expert consensus on diagnosis and treatment of pediatric arterial ischemic stroke[J]. Zhonghua Erke Zazhi, 2022, 60(12): 1248-1252.
[5]	卓秀伟, 李久伟, 孟令丙, 等. 儿童动脉缺血性脑卒中的分型[J]. 中华医学杂志, 2024, 104(31): 2875-2880.
	Zhuo XW, Li JW, Meng LB, et al. Classification of childhood arterial ischemic stroke[J]. Zhonghua Yixue Zazhi, 2024, 104(31): 2875-2880.
[6]	Mackay MT, Wiznitzer M, Benedict SL, et al. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study[J]. Ann Neurol, 2011, 69(1): 130-140. doi: 10.1002/ana.22224 pmid: 21280083
[7]	Mastrangelo M, Giordo L, Ricciardi G, et al. Acute ischemic stroke in childhood: a comprehensive review[J]. Eur J Pediatr, 2022, 181(1): 45-58.
[8]	Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(3): e51-e96. doi: 10.1161/STR.0000000000000183
[9]	王建军, 邹丽萍, 石凯丽, 等. 北京市儿童医院10年儿童脑卒中疾病谱回顾性分析[J]. 中国循证儿科杂志, 2007, 2(4): 259-264.
	Wang JJ, Zhou LP, Shi KL, et al. Retrospective analysis of the disease spectrum of stroke in childhood[J]. Zhongguo Xunzheng Erke Zazhi, 2007, 2(4): 259-264.
[10]	孙丹, 刘智胜, 金润铭, 等. 儿童缺血性脑卒中42例病因影像学特征及预后临床回顾分析[J]. 中国实用儿科杂志, 2014, 29(2): 141-145.
	Sun D, Liu ZS, Jin RM, et al. Arterial ischemic stroke in 42 children: a retrospective study of etiology, radiologic features and prognosis[J]. Zhongguo Shiyong Erke Zazhi, 2014, 29(2): 141-145.
[11]	李久伟, 蒋丽琼, 王建军, 等. 不同影像学检查对儿童动脉缺血性脑卒中的诊断价值[J]. 实用儿科临床杂志, 2008, 23(12): 900-902.
	Li JW, Jiang LQ, Wang JJ, et al. Diagnostic values of different kinds of imageology examination on artery ischemic stroke in children[J]. Shiyong Erke Linchuang Zazhi, 2008, 23(12): 900-902.
[12]	Jiang B, Hills NK, Forsyth R, et al. Imaging predictors of neurologic outcome after pediatric arterial ischemic stroke[J]. Stroke, 2021, 52(1): 152-161. doi: 10.1161/STROKEAHA.120.030965 pmid: 33280552
[13]	俞祯妮, 马雯慧, 段志玲, 等. 高分辨率磁共振血管壁成像在原发性中枢神经系统血管炎中的研究进展[J]. 现代医用影像学, 2024, 33 (6): 1179-1184.
	Yu ZN, Ma WH, Duan ZL, et al. Research progress of high resolution magnetic resonance vascular wall imaging in primary central nervous system vasculitis[J]. Xiandai Yiyong Yingxiangxue, 2024, 33(6):1179-1184.
[14]	中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组, 中国医师协会神经内科医师分会神经免疫专员委业会. 原发性中枢神经系统血管炎诊断和治疗中国专家共识[J]. 中国神经免疫学和神经病学杂志, 2017, 24(4): 229-239.
	The Neurological Immunology Branch of the Chinese Society for Immunology, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Primary Central Nervous System Vasculitis[J]. Zhongguo Shenjing Mianyixue He Shenjingbingxue Zazhi, 2017, 24(4): 229-239.
[15]	付彬, 李海波, 叶启东, 等. ADA2基因变异与腺苷脱氨酶2缺乏症的研究进展[J]. 中国中西医结合儿科学, 2024, 16(2): 102-106.
	Fu B, Li HB, Ye QD, et al. Research progress of ADA2 gene mutation and the deficiency of adenosine deaminase 2[J]. Zhongguo Zhongxiyi Jiehe Erkexue, 2024, 16(2): 102-106.
[16]	Monagle P, Barnes C, Ignjatovic V, et al. Developmental haemostasis. Impact for clinical haemostasis laboratories[J]. Thromb and Haemost, 2006, 95(2): 362-372.
[17]	Dicpinigaitis AJ, Gandhi CD, Pisapia J, et al. Endovascular thrombectomy for pediatric acute ischemic stroke[J]. Stroke, 2022, 53(5): 1530-1539. doi: 10.1161/STROKEAHA.121.036361 pmid: 35272483
[18]	Bilgin C, Ibrahim M, Azzam AY, et al. Mechanical thrombectomy for pediatric large vessel occlusions: a systematic review and meta-analysis[J]. Clinical Neuroradiology, 2023, 33(3): 635-644. doi: 10.1007/s00062-022-01246-y pmid: 36592199
[19]	Bhatia KD, Briest R, Goetti R, et al. Incidence and natural history of pediatric large vessel occlusion stroke: a population study[J]. JAMA neurology, 2022, 79(5): 488-497. doi: 10.1001/jamaneurol.2022.0323 pmid: 35344005
[20]	Sporns PB, Psychogios MN, Straeter R, et al. Clinical diffusion mismatch to select pediatric patients for embolectomy 6 to 24 hours after stroke: an analysis of the save child study[J]. Neurology, 2021, 96(3): e343-e351. doi: 10.1212/WNL.0000000000011107 pmid: 33144517
[21]	Bodey C, Goddard T, Patankar T, et al. Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke[J]. Eur J Paediat Neuro, 2014, 18(6): 730-735.
[22]	赵晶, 王运良. 中枢神经系统原发性血管炎的研究进展[J]. 中国实用神经疾病杂志, 2016, 19(1): 141-142.
	Zhao J, Wang YL. Research progress on primary central nervous system vasculitis[J]. Zhongguo Shiyong Shenjing Jibing Zazhi, 2016, 19(1): 141-142.
[23]	Barron KS, Aksentijevich I, Deuitch NT, et al. The spectrum of the deficiency of adenosine deaminase 2: an observational analysis of a 60 patient cohort[J]. Front Immunol, 2021, 12: 811473.
[24]	Fullerton HJ, Wu YW, Sideny S, et al. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging[J]. Pediatrics, 2007, 119(3): 495-501. doi: 10.1542/peds.2006-2791 pmid: 17332202
[25]	池彬, 侯鹏伟, 陈力, 等. 重型创伤性脑损伤患者预后不良的影响因素分析[J]. 中华神经医学杂志, 2024, 23(6): 592-597.
	Chi B, Hou PW, Chen L, et al. Influencing factors for poor prognosis in patients with severe traumatic brain injury[J]. Zhonghua Shenjing Yixue Zazhi, 2024, 23(6): 592-597.
[26]	赵晗, 朱奕雄, 李钢. 颅脑损伤患者并发创伤性脑梗死临床特点及危险因素分析[J]. 中国医师进修杂志, 2024, 47(2): 112-116.
	Zhao H, Zhu YX, Li G. Clinical features and risk factors analysis of traumatic cerebral infarction in patients with craniocerebral trauma[J]. Zhongguo Yishi Jingxiu Zazhi, 2024, 47, (2):112-116.
[27]	董会卿. 原发性中枢神经系统血管炎的诊断与治疗[J]. 神经病学与神经康复学杂志, 2019, 15(1): 36-41.
	Dong HQ. Diagnosis and treatment of primary angiitis of the central nervous system[J]. Shenjingbingxue Yu Shenjing Kangfuxue Zazhi, 2019, 15(1): 36-41.

类别	基本特征	n（%）
性别	男	11（40.7）
性别	女	16（59.2）
发病年龄	≤1岁	8（29.3）
	1~6岁	7（25.9）
	≥6岁	12（44.5）
前驱病史	呼吸道感染	7（25.9）
	疫苗接种	1（3.7）
	外伤	6（22.2）
	无	13（48.1）
发病时间	<4.5 h	3（11.1）
	4.5~24 h	10（37.0）
	>24 h	14（51.8）
病程	双相病程	1（3.7）
病程	单相或慢性病程	26（96.3）
受累血管	大脑中动脉	12（44.4）
	大脑后动脉	2（7.4）
	大脑前动脉	1（3.7）
	基底动脉	6（22.2）
	颈内动脉	3（11.1）
	椎动脉	1（3.7）
	无大动脉受累	7（25.9）
	单支血管受累	16（59.2）
	2支血管受累	1（3.7）
	≥3支血管	3（11.1）

分型		亚组疾病	n(%)
炎症性（I）	非感染性	SLE	2（7.4）
		过敏性紫癜	1（3.7）
		原发性中枢神经系统血管炎	3（11.1）
		局灶性脑动脉病-炎症型	1（3.7）
	感染性	支原体感染	2（7.4）
		水痘感染	1（3.7）
		EB病毒感染	1（3.7）
血管结构异常（S）动脉夹层		烟雾病	3（11.1）
血管结构异常（S）动脉夹层			1（3.7）
易栓症（T）			0（0）
心脏疾病（C）			0（0）
其他可确定病因（O）		创伤性脑梗死	6（22.2）
病因不能确定			6（22.2）

症状分类		首发临床事件数
肌无力	面瘫	3（6.3）
	偏瘫	14（29.7）
	单瘫	1（2.1）
	双侧瘫痪	1（2.1）
	四肢瘫痪	1（2.1）
惊厥发作		6（12.7）
语言障碍		2（4.2）
感觉异常		1（2.1）
头晕、头痛		8（17.0）
视力障碍		2（4.2）
意识水平下降		7（14.9）
共济失调		1（2.1）
总计		47