微栓子检测对不同类型急性非心源性脑梗死的应用价值  

作　　者：桂小红[1] 王芳[1] 王黎萍[1] 吴承龙[1] 

机构地区：[1]浙江省绍兴市人民医院,312000

出　　处：《浙江临床医学》2021年第11期1578-1580,1583,共4页Zhejiang Clinical Medical Journal

基　　金：绍兴市卫生计生委科技计划项目(2017QN006)。

摘　　要：目的探讨不同类型急性非心源性脑梗死微栓子信号(MES)的阳性率及影响因素,以及MES阳性患者单联与双联抗血小板的治疗效果方法根据中国缺血性卒中亚型(CISS)分型,选取240例发病48 h内急性非心源性脑梗死患者,采用经颅多普勒超声(TCD)对所有患者进行大脑中动脉及大脑后动脉MES检测,以及对所有患者治疗前后进行美国国立卒中研究院神经功能缺损量表评分(NIHSS)及改良Ranking评分(mRS),对MES阳性患者发病机制各亚型构成比进行分析以及采用单因素及多因素Lo扣dc回归分析筛查MES阳性危险因素及与临床分型的相关性,以及对MES阳性者分别予拜阿司匹林单药治疗或联合氣吡格雷双联抗血小板治疗,评价治疗效果及预后结果急性非心源性脑梗死240例中MES阳性65例(27.1%),以颅内外大动脉粥样硬化型脑梗死中的低灌注/栓子清除下降机制及混合型机制亚型检出率最高;MES阳性组颈部斑块特征、基线NIHSS评分、C1SS分型以及颅内外大动脉粥样硬化亚型与MES阴性组比较差异有统计学意义(P<0.05)MES阳性组病情进展及卒中复发的发生率与MES阴性组比较差异有统计学意义(P<0.05)Logistic回归分析显示,发病至检测间隔时间(P=0.020),颅内外动脉粥样硬化亚型以低灌注/栓子清除下降机制(P<0.001)及混合型机制(P=0.001)均是MES阳性的独立危险因素:MES阳性患者双抗组治疗后第7天及第14天N1HSS评分及mRS评分均低于单抗组(P<0.05),双抗组治疗后第7天及第14天MES数量少于单抗组(P<0.05),双抗组病情进展人数少于单抗组(P<0.05)结论急性非心源性脑梗死亚型分析发现以低灌注/栓子清除下降机制及混合型机制亚型MES检出率最高,且是MES阳性的独立危险因素,MES阳性患者病情进展及卒中复发风险较高;MES阳性患者双抗治疗优于单抗治疗,可以改善预后。Objective To explore the prevalence of niicroembolic signal(MES)in acute non-cardiogenic cerebral infarction,analyze the influencing factors of the MESand evaluate the clinical effect of single and dual antiplatlet therapy in patients with MES.Methods According to the classification of Chinese Ischemic Stroke Subclassification(CISS),240 patients with acute non-cardiogenic cerebral infarction within 48 hours after onset were selected.All patients were tested by the trans-cranial Doppler(TCD)monitoring middle cerebral artery and posterior cerebral artery to detec t MES.Univariate and multivariate logistic regression analysis were adopted to analyze and screen the positive risk factors for MES.All patients were classified by Chinese Ischemic Stroke Subclassification(CISS)and they were all evaluated by National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS).Univariate and multivari«ite Logistic regression analysis were adopted to.analyze«ind screen the positive risk factors for MES.The effects and prognosis were ev«iluated by treatment of aspirin and combination therapy of aspirin and clopidogrel.Results 65 patients(27.1%)were detected MES positive.The highest detection rate was found in the hypoperfusion/impaired emboli clearance mechanism and multiple mechanism subtypes ofintracrani.il and extracranial arteriosclerosis cerebral infarction.There were significant differences in the characteristics of carotid plaque,baseline NIHSS score,CISS typing,intracranial and extracrani«il arteriosclerosis cerebral infarction subtype between MES negative group and MES Positive Group(P<0.05).The disease progression and stroke recurrence in MES positive group were significantly higher than those in MES neg.itive group(P<0.05).According to Logistic regression analysis,time from disease onset to detection(P=0.020)and hypoperfusion/impaired emboli clearance mechanism(P<0.001)and multiple mechanism subtypes(P=0.001)were the independent risk factor of patients with MES positive.The NIHSS score and mRS score

关 键 词：脑梗死 经颅多普勒 微栓子信号 卒中 复发 

分 类 号：R74[医药卫生—神经病学与精神病学]