卵圆孔未闭相关卒中、心房颤动相关卒中与动脉-动脉脑栓塞患者临床与影像学分析  

Analysis of the clinical and imaging of patients with patent foramen ovale associated stroke,atrial fibrillation associated stroke and artery-to-artery embolism

作　　者：迟冬雨 宋秀娟[1] 马杰 王丽萍 张晗 Chi Dongyu;Song Xiujuan;Ma Jie;Wang Liping;Zhang Han(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000 [2]河北医科大学第二医院心脏超声科,石家庄050000 [3]河北医科大学第一医院心血管外科

出　　处：《脑与神经疾病杂志》2024年第9期557-562,共6页Journal of Brain and Nervous Diseases

基　　金：政府资助临床优秀人才培养项目(ZF2023119);河北省医学科学研究课题(20211276)。

摘　　要：目的 探讨卵圆孔未闭(PFO)相关卒中、心房颤动(AF)相关卒中与动脉-动脉(A-A)脑栓塞患者在临床资料、神经影像学特征等方面的差异。方法 收集2021年9月至2022年12月在河北医科大学第二医院神经内科住院治疗的初诊病因不明确的卒中患者。将所有入组患者根据病因分为动脉-动脉栓塞(A-A)组,PFO相关卒中组及AF相关卒中组,比较不同致病机制的脑栓塞患者临床特点,总结不同栓子来源的脑栓塞患者影像学特征。结果 本研究共纳入184例脑栓塞患者,其中PFO组75例,AF组45例,A-A组64例。PFO组平均年龄、高血压、糖尿病、既往卒中病史比例低于AF组与A-A组,差异均有统计学意义(^(均)P<0.05)。AF组平均年龄、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分量表(mRS)评分高于PFO组与A-A组,差异有统计学意义(^(均)P<0.05)。在影像学上,3组患者在梗死血管分布、病灶大小及部位上比较差异有统计学意义(^(均)P <0.05)。PFO组患者相比AF组与A-A组,累及后循环区域较多,皮质下梗死多见(^(均)P<0.05);AF组患者相比于PFO组与A-A组,以皮质-皮质下梗死为主,更多累及多循环供血区域(^(均)P<0.05)。PFO组患者根据是否合并有高危PFO特征分为高危PFO组患者53例,非高危PFO组患者22例。两组患者梗死血管分布、病灶大小、部位和数量比较差异均无统计学意义(^(均)P> 0.05)。结论 PFO相关卒中患者一般年龄较小,高血压、糖尿病、既往卒中病史等传统心脑血管危险因素较少,在神经影像学上以皮质下梗死为主,更多累及后循环。AF相关卒中患者年龄偏大,NIHSS评分、mRS评分较高,影像学上以大的皮质-皮质下梗死为主,多累及多循环供血区域。Objective To investigate the differences in clinical data and neuroimaging features of patients with patent foramen ovale(PFO)related stroke,atrial fibrillation(AF)related stroke and artery-artery(A-A)cerebral embolism.Methods The Preliminary diagnosis stroke patients with unclear etiology who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University from September 2021 to December 2022 were collected.All enrolled patients were divided into A-A group,patent foramen oval-related stroke group and atrial fibrillation(AF)related stroke group according to their etiology.Clinical characteristics of cerebral embolism patients with different pathogenic mechanisms were compared,and imaging characteristics of cerebral embolism patients with different embolic sources were summarized.Results A total of 184 patients with cerebral embolism were included in this study,including 75 cases in PFO group,45 cases in AF group,and 64 cases in A-A group.The mean age,hypertension,diabetes and history of stroke in PFO group were lower than those in AF group and A-A group,and the differences were statistically significant(P<0.05).On imaging,there were statistically significant differences in infarct vessel distribution,lesion size and location among the three groups(P<0.05).Compared with AF group and A-A group,the posterior circulation area was more involved in PFO group,and subcortical infarction was more common(P<0.05).Compared with PFO group and A-A group,AF group mainly had cortical-subcortical infarction and more involved multi-circulation blood supply areas(P<0.05).Patients in PFO group were divided into high-risk PFO group(53 cases)and non-high-risk PFO group(22 cases)according to whether they had high-risk PFO characteristics.There were no significant differences in infarct vessel distribution,lesion size,location and number between the two groups(P>0.05).Conclusion Patients with PFO-related stroke are generally younger in age and have fewer traditional cardiovascular and cerebrovascular r

关 键 词：不明原因栓塞性脑卒中 卵圆孔未闭 房颤 动脉-动脉栓塞 

分 类 号：R743.32[医药卫生—神经病学与精神病学]