CAJ | 학술논문

目的探讨急性缺血性卒中患者微栓子信号(microembolic signals,MES)与转归的相关性.方法纳入急性缺血性卒中患者,应用经颅多普勒彩色超声动态监测大脑中动脉MES,彩色多普勒超声评价颈动脉斑块,MRI评价缺血性卒中早期病灶,美国国立卫生研究院卒中量表评价神经功能缺损,改良Rankin量表评价转归,并登记卒中复发情况.结果共纳入135例急性缺血性卒中患者,其中心源性脑栓塞33例,大动脉粥样硬化性卒中49例、小动脉闭塞性卒中24例、其他明确病因或原因不明性卒中29例.多变量logistic回归分析显示,冠心病[优势比(odds ratio,OR)5.862,95％可信区间(confidence interval,CI)2.008 ～ 17.114,P=0.000]是卒中发病后48 h内MES阳性的独立危险因素,而抗栓治疗史(OR 0.376,95％ CI 0.141 ～0.998,P=0.045)则是其独立保护因素；此外,冠心病(OR 4.879,95％ CI 1.257 ～ 18.939;P =0.033)、高血压(OR 4.958,95％ CI 1.029 ～23.882;P=0.030)和糖尿病(OR 3.659,95％ CI 1.027 ～ 13.034;P =0.050)是卒中发病后1周内MES阳性的独立危险因素.MES阳性患者基线和1周时NIHSS评分以及3个月时临床转归与MES阴性患者均无显著差异,但卒中复发和死亡事件显著增多(P=0.019).结论发病48 h内MES与急性缺血性卒中患者3个月时的转归无关,但MES阳性患者3个月内卒中复发和死亡等终点事件发生率显著增高.
목적 탐토급성결혈성졸중환자미전자신호(microembolic signals,MES)여전귀적상관성.방법 납입급성결혈성졸중환자,응용경로다보륵채색초성동태감측대뇌중동맥MES,채색다보륵초성평개경동맥반괴,MRI평개결혈성졸중조기병조,미국국립위생연구원졸중량표평개신경공능결손,개량Rankin량표평개전귀,병등기졸중복발정황.결과 공납입135례급성결혈성졸중환자,기중심원성뇌전새33례,대동맥죽양경화성졸중49례、소동맥폐새성졸중24례、기타명학병인혹원인불명성졸중29례.다변량logistic회귀분석현시,관심병[우세비(odds ratio,OR)5.862,95％가신구간(confidence interval,CI)2.008 ～ 17.114,P=0.000]시졸중발병후48 h내MES양성적독립위험인소,이항전치료사(OR 0.376,95％ CI 0.141 ～0.998,P=0.045)칙시기독립보호인소；차외,관심병(OR 4.879,95％ CI 1.257 ～ 18.939;P =0.033)、고혈압(OR 4.958,95％ CI 1.029 ～23.882;P=0.030)화당뇨병(OR 3.659,95％ CI 1.027 ～ 13.034;P =0.050)시졸중발병후1주내MES양성적독립위험인소.MES양성환자기선화1주시NIHSS평분이급3개월시림상전귀여MES음성환자균무현저차이,단졸중복발화사망사건현저증다(P=0.019).결론 발병48 h내MES여급성결혈성졸중환자3개월시적전귀무관,단MES양성환자3개월내졸중복발화사망등종점사건발생솔현저증고.
Objective To investigate the correlation of microembolic signals (MES) and outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.The MES of middle cerebral artery was monitored dynamically using transcranial color Doppler ultrasound.The early lesions of ischemic stroke were evaluated by MRI.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits.The modified Rankin scale was used to evaluate the outcome,and the stroke recurrence was recorded.Results A total of 135 patients with acute ischemic stroke were enrolled,in which,33 were cardiogenic cerebral embolism,49 were large artery atherosclerotic stroke,24 were small arterial occlusive stroke,and 29 were other clear causes or cryptogenic stroke.Multivariate logistic regression analysis showed that coronary heart disease (odds ratio [OR],5.862,95％ confidence interval [CI] 2.008-17.114; P =0.000) was the independent risk factor for positive MES within 48 hours after stroke onset,while the history of antithrombotic treatment (OR 0.376,95％ CI 0.141-0.998; P =0.045) was its independent protective factor.In addition,coronary heart disease (OR 4.879,95％ CI 1.257-18.939; P =0.033),hypertension (OR 4.958,95％ CI 1.029-23.882; P =0.030),and diabetes (OR 3.659,95％ CI 1.027-13.034; P =0.050) were the independent risk factors for positive MES within 1 week after stroke onset.The NIHSS scores of the patients of the positive MES at baseline and 1 week and the clinical outcome at 3 months had no significant differences with the patients of negative MES,however,stroke recurrence and deaths increased significantly (P =0.019).Conclusions MES within 48 hours of onset was not associated with the outcome in patients with acute ischemic stroke at 3 months,however,the incidence of endpoint events such as recurrence and death was significantly higher in patients of positive MES within 3 months.