急性缺血性卒中患者的微栓子信号与转归：前瞻性病例系列研究  

Microemlmlic signals stroke： a prospective and oUtcome in patients case series study

作　　者：姜建东[1] 姜玉龙[1] 冯寿琴[2] 孙德锦[1] 庄爱霞[1] 曾庆宏[1] 张毅[3] 黄红梅[4] 聂红霞[1] 周芳[1] 

机构地区：[1]连云港市第二人民医院,蚌埠医学院附属连云港医院神经内科,222023 [2]连云港市第二人民医院,蚌埠医学院附属连云港医院神经功能检查科,222023 [3]连云港市第二人民医院,蚌埠医学院附属连云港医院放射科,222023 [4]连云港市第二人民医院,蚌埠医学院附属连云港医院超声室,222023

出　　处：《国际脑血管病杂志》2012年第9期678-685,共8页International Journal of Cerebrovascular Diseases

基　　金：连云港市卫生局基金（ZC107）

摘　　要：目的探讨急性缺血性卒中患者微栓子信号（microembolicsignals，MES）与转归的相关性。方法纳入急性缺血性卒中患者，应用经颅多普勒彩色超声动态监测大脑中动脉MES，彩色多普勒超声评价颈动脉斑块，MRJ评价缺血性卒中早期病灶，美国国立卫生研究院卒中量表评价神经功能缺损，改良Rankin量表评价转归，并登记卒中复发情况。结果共纳入135例急性缺血性卒中患者，其中心源性脑栓塞33例，大动脉粥样硬化性卒中49例、小动脉闭塞性卒中24例、其他明确病因或原因不明性卒中29例。多变量logistic回归分析显示，冠心病[优势比（oddsratio，OR）5．862，95％可信区问（confidenceinterval，CI）2．008～17．114，P=0．000]是卒中发病后48h内MES阳性的独立危险因素，而抗栓治疗史（OR0．376，95％CI0．141～0．998，P=0．045）则是其独立保护因素；此外，冠心病（OR4．879，95％CI1．257～18．939；P=0．033）、高血压（OR4．958，95％CI1．029～23．882；P=0．030）和糖尿病（OR3．659，95％CI1．027～13．034；P=0．050）是卒中发病后1周内MES阳性的独立危险因素。MES阳性患者基线和1周时NIHSS评分以及3个月时临床转归与MES阴性患者均无显著差异，但卒中复发和死亡事件显著增多（P=0．019）。结论发病48h内MES与急性缺血性卒中患者3个月时的转归无关，但MES阳性患者3个月内卒中复发和死亡等终点事件发生率显著增高。Objective To investigate the correlation of microembolic signals （MES） and outcome in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke were enrolled in the study. The MES of middle cerebral artery was monitored dynamically using transcranial color Doppler ultrasound. The early lesions of ischemic stroke were evaluated by MRI. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate neurological deficits. The modified Rankin scale was used to evaluate the outcome, and the stroke recurrence was recorded. Results A total of 135 patients with acute ischemic stroke were enrolled, in which, 33 were cardiogenic cerebral embolism, 49 were large artery atherosclerotic stroke, 24 were small medal occlusive stroke, and 29 were other clear causes or cryptogenic stroke. Multivariate logistic regression analysis showed that coronary heart disease （odds ratio [ OR], 5. 862, 95% confidence interval [ CI] 2. 008 - 17. 114; P = 0. 000） was the independent risk factor for positive MES within 48 hours after stroke onset, while the history of antithrombotic treatment （OR O. 376, 95% C10. 141 - 0. 998; P = 0. 045） was its independent protective factor. In addition, coronary heart disease （OR 4. 879, 95% CI 1. 257 - 18. 939; P = 0. 033）, hypertension （OR 4. 958, 95% C1 1. 029 - 23. 882; P = 0. 030） , and diabetes （OR 3. 659, 95% C11. 027 - 13. 034; P = 0. 050） were the independent risk factors for positive MES within 1 week after stroke onset. The NIHSS scores of the patients of the positive MES at baseline and 1 week and the clinical outcome at 3 months had no significant differences with the patients of negative MES, however, stroke recurrence and deaths increased significantly （P =0. 019）. Conelmiom MES within 48 hours of onset was not associated with the outcome in patients with acute ischemic stroke at 3 months, however, the incidence of endpoint events such as recurrence and death was sigaificantly higher in patients of positive MES within 3 mo

关 键 词：颅内栓塞和血栓形成 卒中 脑缺血 超声检查 多普勒 经颅 脑血管循环 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]