右向左分流与隐源性卒中患者梗死模式的相关性  

Correlation between right-to-left shunt and infarct pattern in patients with cryptogenic stroke

作　　者：钱海舟[1] 殷琳玲 杨欢[1] 张珊珊 胡丹[1] 余芾成[1] 张洪[2] Qian Haizhou;Yin Linling;Yang Huan;Zhang Shanshan;Hu Dan;Yu Feicheng;Zhang Hong(Department of Neurology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432000,China;Department of Neurology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉科技大学附属孝感医院神经内科,孝感432000 [2]武汉大学中南医院神经内科,430071

出　　处：《国际脑血管病杂志》2020年第8期587-592,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨右向左分流(right-to-left shunt, RLS)与隐源性卒中患者梗死模式的相关性。方法:回顾性纳入2016年5月至2020年1月孝感中心医院神经内科收治的中青年急性隐源性卒中患者,记录人口统计学资料、血管危险因素、基线血压、实验室检查结果、卒中严重程度、梗死部位及分布模式。按照经颅多普勒发泡试验结果分为RLS组和无RLS组;根据弥散加权成像结果分为单病灶组和多病灶组。应用多变量 logistic回归分析确定RLS与梗死模式的相关性。 结果:共纳入68例急性隐源性卒中患者,男性37例(54.4%),年龄(47.63±6.57)岁(范围31-59岁)。30例(44.1%)存在RLS,其中轻度分流22例(73.3%),重度分流8例(26.7%)。RLS组男性、皮质-皮质下梗死及多供血区病变患者比例显著高于无RLS组;而三酰甘油、体重指数以及皮质下梗死和单血管供血区单个病变患者比例显著低于无RLS组( P均<0.05)。多病灶组前循环+后循环梗死、皮质-皮质下梗死以及伴有RLS的患者比例显著高于单病灶组,而皮质下梗死患者比例显著低于单病灶组( P均<0.05)。多变量 logistic回归分析显示,伴有RLS是发生多发性梗死的独立危险因素(优势比6.681,95%可信区间1.206-37.019;P=0.030)。 结论:RLS与隐源性卒中患者多发性梗死独立相关。Objective To investigate the correlation between right-to-left shunt(RLS)and infarct pattern in patients with cryptogenic stroke.Methods Young and middle-aged patients with acute cryptogenic stroke admitted to the Department of Neurology,Xiaogan Central Hospital from May 2016 to January 2020 were enrolled retrospectively.The demographic data,vascular risk factors,baseline blood pressure,laboratory findings,stroke severity,infarct location and distribution pattern were documented.The patients were divided into RLS group and non-RLS group according to the findings of the transcranial Doppler ultrasound foaming test.They were divided into single lesion group and multiple-lesion group according to the findings of diffusion-weighted imaging.Multivariate logistic regression analysis was used to identify the correlation between RLS and infarct pattern.Results A total of 68 patients with acute cryptogenic stroke were included,37 of them were male(54.4%),and their age was 47.63±6.57 years(range,31-59 years).Thirty patients(44.1%)had RLS,including 22(73.3%)with mild shunt and 8(26.7%)with severe shunt.The proportions of men,cortical-subcortical infarction and multiple blood supply area lesions in the RLS group were significantly higher than those in the non-RLS group,while triacylglycerol,body mass index,the proportions of patients with subcortical infarction and single lesions in the single vessel blood supply area were significantly lower than those in the non-RLS group(P<0.05).The proportions of patients with anterior circulation+posterior circulation infarction,cortical-subcortical infarction,and RLS in the multi-lesion group were significantly higher than those in the single-lesion group,while the proportion of patients with subcortical infarction was significantly lower than that in the single-lesion group(all P<0.05).Multivariate logistic regression analysis showed that RLS was an independent risk factor for multiple infarctions(odds ratio 6.681,95%confidence interval 1.206-37.019;P=0.030).Conclusion RLS is indepen

关 键 词：卒中 脑缺血 颅内栓塞 弥散磁共振成像 卵圆孔 未闭 超声检查 多普勒 经颅 

分 类 号：R743.3[医药卫生—神经病学与精神病学]