卵圆孔未闭相关隐源性卒中c-TCD特点及中青年卒中短期不良预后分析  

Characteristics of c-TCD in patent foramen ovale-related cryptogenic stroke and analysis of short-term poor prognosis in young and middle-aged stroke patients

作　　者：樊珂 宋道辉 胡婉华 田怡冉 孙嘉宁 董斌 FAN Ke;SONG Daohui;HU Wanhua;TIAN Yiran;SUN Jianing;DONG Bin(Neurology Department,the Third Affiliated Hospital of Anhui Medical University,Hefei 230041,China;Medical Imaging Center,the Third Affiliated Hospital of Anhui Medical University,Hefei 230041,China)

机构地区：[1]安徽医科大学第三附属医院神经内科,安徽合肥230041 [2]安徽医科大学第三附属医院医学影像中心,安徽合肥230041

出　　处：《临床医学研究与实践》2025年第11期41-45,共5页Clinical Research and Practice

基　　金：2024年度安徽省中医药传承创新科研项目(No.2024CCCX234);合肥市第七周期临床重点(培育)专科建设项目(合卫医秘[2023]72号);合肥市滨湖医院2023年度三新项目(No.202308)。

摘　　要：目的探索经颅多普勒发泡实验(c-TCD)检测中青年卵圆孔未闭(PFO)相关隐源性卒中(PFOCS)的价值及特征,分析中青年卒中预后的影响因素。方法选取2023年3月至2024年5月安徽医科大学第三附属医院南区神经内科收治的121例中青年急性缺血性脑卒中患者作为研究对象,统计患者的临床资料,并开展c-TCD检查,分析影响卒中患者短期预后的独立危险因素。结果121例患者中,PFOCS 20例,大动脉粥样硬化性脑卒中(LAA)42例,小动脉闭塞性脑卒中(SAA)37例,心源性脑栓塞(CE)2例,其他确定原因引起的缺血性脑卒中(SOE)7例,不明原因的缺血性脑卒中(SUE)13例。卵圆孔直径与气泡分级呈正相关(P<0.05)。预后不良组的低密度脂蛋白胆固醇(LDL-C)、甘油三酯水平、入院美国国立卫生院卒中量表(NIHSS)评分、并发症发生率高于预后良好组,病程长于预后良好组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,入院NIHSS评分、并发症是中青年急性缺血性脑卒中患者预后不良的独立危险因素(P<0.05)。入院NIHSS评分、并发症预测短期预后不良的受试者工作特征(ROC)曲线下面积(AUC)分别为0.825、0.740,两者联合预测的AUC为0.848。结论卵圆孔直径与c-TCD气泡分级程度呈正相关,入院NIHSS评分和并发症与中青年卒中短期预后不良独立相关,且两者联合具有一定预测价值。Objective To explore the value and characteristics of contrast-enhanced transcranial Doppler(c-TCD)in patent foramen ovale(PFO)-related cryptogenic stroke(PFOCS)in young and middle-aged people,and to analyze the influencing factors of prognosis of young and middle-aged stroke patients.Methods From March 2023 to May 2024,121 young and middle-aged patients with acute ischemic stroke admitted in the neurology department,southern district of the Third Affiliated Hospital of Anhui Medical University were selected as the research objects.The clinical data of the patients were counted,and c-TCD examination was carried out to analyze the independent risk factors affecting the short-term prognosis of stroke patients.Results Among the 121 patients,there were 20 cases of PFOCS,42 cases of large artery atherosclerotic(LAA),37 cases of small-artery occlusion lacunar(SAA),2 cases of cardioembolism(CE),7 cases of stroke of other demonstrated etiology(SOE),and 13 cases of stroke of undemomtrated etiology(SUE).The diameter of foramen ovale was positively correlated with bubble classification(P<0.05).The low density lipoprotein-cholesterol(LDL-C),triglyceride levels,National Institutes of Health Stroke Scale(NIHSS)score at admission and complication rate in poor prognosis group were higher than those in good prognosis group,the course of disease was longer than that in the good prognosis group,and the differences were statistically significant(P<0.05);multivariate Logistic regression analysis results showed that the NIHSS score at admission and complications were independent risk factors for poor prognosis in young and middle-aged patients with acute ischemic stroke(P<0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)of NIHSS score at admission and complications predicting short-term poor prognosis were 0.825 and 0.740,respectively,and the AUC of the combined prediction was 0.848.Conclusion The diameter of the foramen ovale is positively correlated with the degree of c-TCD bubble classification.The NIHSS

关 键 词：卵圆孔未闭 隐源性卒中 经颅多普勒发泡实验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]