【摘要】 目的 观察不同病因所致急性颅内大血管闭塞缺血性卒中患者血栓的病理学特征。方法 前瞻性收集单中心2018年12月至2021年2月收治的行血管内治疗（endovascular treatment, EVT）的急性缺血性卒中患者颅内血栓标本及临床资料。采用HE染色对比血栓病理形态特征，用病理图像分析软件行定量分析。结果 共纳入99例患者，按照改良TOAST(trial of Org 10 172 in acute stroke treatment,TOAST)分型进行分组，大动脉粥样硬化（atherosclerotic, AT）组30例（30/99,30.3%），心源性栓塞（cardioembolic,CE）组59例（59/99,59.6%），不明原因型（some undetermined etiology,SUE）组10例（10/99,10.1%）。相比AT组，CE组和SUE组中Fibrin/PLT含量较高，RBC含量较低（P<0.001）。CE组血栓中白色血栓比例高而红色血栓比例低（P=0.020），而混合性血栓在不同病因间无统计学差异（P=0.432）。乏红细胞血栓仅存在于非AT组，而泛红细胞血栓仅存在于AT组。“胭脂征”在CE组中发现率高于AT组（28.8%vs. 10%,P=0.037），而“花豹征”仅出现在CE组（4/59,6.8%）。结论 乏红细胞血栓的AIS患者病因是CE或SUE，泛红细胞血栓病因是AT，而具有“胭脂征”、“花豹征”特征的颅内血栓的病因多倾向于CE。更多还原

【Abstract】 Objective To observe the pathological characteristics of thrombi in patients with acute intracranial large vessel occlusion caused by different etiologies.Methods Thrombi and clinical data of acute ischemic stroke (AIS)treated by endovascular treatment (endovascular treatment,EVT) in a single center from December 2018 to February 2021were prospectively collected.HE staining was used to compare the pathological features of thrombus,and quantitatively analysis using image soft.Results A total of 99 cases were included,of which 30 cases (30/99,30.3%) were atherosclerotic (atherosclerotic,AT),59 cases (59/99,59.6%) were cardioembolic (cardioembolic,CE),and 10 cases(10/99,10.1%) were some undetermined etiology (some undetermined etiology,SUE),respectively.Compared with AT group,there was a higher proportion of white thrombosis and a lower red thrombus in CE group and SUE group (P<0.001).In the CE group,the proportion of white thrombus was lower (P=0.020),while mixed thrombus showed no significant difference among different etiologies (P=0.432).Poor erythrocytes thrombi were found only in non-AT group,while rich erythrocytes thrombi were found in AT group only.The"rouge sign"was found to be higher in the CE than in the AT(28.8%vs.10%,P=0.037),while the"leopard-print sign"appeared in the CE(4/59,6.8%) only.Conclusions The disease of AIS patients with poor erythrocytes thrombus is caused by CE or SUE,and rich erythrocytes thrombus is caused by AT,while the etiology of intracranial thrombus with"rouge sign"and"leopard-print sign"tends to be CE.更多还原