不明原因栓塞性卒中的主动脉斑块分析  

Analysis of aortic plaques in embolic stroke of undetermined source

作　　者：李焱 陈健[2] 李倩 徐朝伟[2] 楼敏芳 LI Yan;CHEN Jian;LI Qian;XU Chaowei;LOU Minfang(Second Clinical College of Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;Department of Neurology,Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China;Department of Neurology,Quzhou Hospital of Traditional Chinese Medicine,Quzhou 324002,Zhejiang,China)

机构地区：[1]浙江中医药大学第二临床学院,浙江杭州310053 [2]金华市中心医院神经内科,浙江金华321000 [3]衢州市中医院神经内科,浙江衢州324002

出　　处：《中国现代医生》2024年第7期46-50,共5页China Modern Doctor

摘　　要：目的探索不明原因栓塞性卒中(embolic stroke of undetermined source,ESUS)患者的主动脉斑块(aortic plaque,AP)发生、分布情况、危险因素及临床表现。方法选取2022年9月至2023年9月于金华市中心医院住院的222例ESUS患者,所有患者均行胸部计算机体层血管成像检查,观察AP的发生分布情况及斑块特征。根据有无斑块及斑块特征将患者分为无斑块组(n=126)、AP组(n=71)和主动脉复杂斑块(aortic complex plaque,ACP)组(n=25)。分析AP的危险因素及三组患者的脑梗死临床表现差异。结果纳入222例ESUS患者,共检出259枚AP,42枚ACP,斑块分布以近端降主动脉最常见。多因素Logistic回归分析结果显示,年龄、糖尿病、左室舒张功能不全均是ESUS患者发生AP的独立危险因素(P<0.05),年龄、糖尿病、左室舒张功能不全、心脏瓣膜钙化均是ESUS患者发生ACP的独立危险因素(P<0.05)。无斑块组患者的入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分显著低于AP组(P<0.05),无斑块组和ACP组患者的入院时NIHSS评分、前循环脑梗死病灶分布比较差异均有统计学意义(P<0.05)。结论在ESUS患者中AP的发生率较高,主要分布于近端降主动脉,ACP往往多发。年龄的增加、糖尿病、左室舒张功能不全及心脏瓣膜钙化与ACP形成独立相关。与无斑块的ESUS患者相比,有ACP的患者通常卒中症状更严重,其脑梗死病灶多分布在左侧大脑半球。Objective To explore the occurrence,distribution,risk factors,and clinical manifestations of aortic plaques(AP)in patients with embolic stroke of undetermined source(ESUS).Methods A total of 222 ESUS patients admitted to Jinhua Municipal Central Hospital from September 2022 to September 2023 were selected.Computed tomography angiography was performed in all patients to observe the occurrence,distribution and characteristics of AP.According to the presence or absence of plaques and the characteristics of plaques,the patients were divided into non-plaque group(n=126),AP group(n=71)and aortic complex plaque(ACP)group(n=25).The risk factors of AP and the difference of clinical manifestation of cerebral infarction among three groups were analyzed.Results In 222 ESUS patients,259 AP and 42 ACP were detected,and plaques were most common in the proximal descending aorta.Multivariate Logistic regression analysis showed that age,diabetes mellitus and left ventricular diastolic dysfunction were all independent risk factors for AP in ESUS patients(P<0.05),while age,diabetes mellitus,left ventricular diastolic dysfunction and heart valve calcification were all independent risk factors for ACP in ESUS patients(P<0.05).The National Institutes of Health stroke scale(NIHSS)score on admission in non-plaque group was significantly lower than that in AP group(P<0.05).There were statistically significant differences in NIHSS score on admission and distribution of anterior circulation cerebral infarction lesions between non-plaque group and ACP group(P<0.05).Conclusion In ESUS patients,the incidence of AP is relatively high,primarily distributed in the proximal descending aorta,and ACP is often multiple.Increasing age,diabetes mellitus,left ventricular diastolic dysfunction,and heart valve calcification are independently associated with the formation of ACP.Compared to ESUS patients without plaques,patients with ACP usually have more severe stroke symptoms,and the cerebral infarction lesions are more distributed in the left cerebral h

关 键 词：不明原因栓塞性卒中 主动脉斑块 近端降主动脉 复杂斑块 

分 类 号：R743.3[医药卫生—神经病学与精神病学]