CAJ | 학술논문

目的微栓子信号(MES)提示可能存在不稳定斑块,有近期缺血性卒中复发可能.本文旨在探讨大动脉粥样硬化(LAA)型脑梗死患者MES阳性率及影响因素,以及MES与缺血性卒中复发的关系.方法连续纳入178例颈内动脉系统LAA型脑梗死患者,所有患者行MES监测并定期随访观察.统计分析MES阳性率及其影响因素,并进一步分析MES阳性及阴性患者卒中复发的比例和风险.结果 178例LAA型脑梗死患者中有29例MES阳性(16.3％).MES阳性组与阴性组患者在高密度脂蛋白[(0.949 ±0.204) mmol/L比(1.066±0.225) mmol/L,t=2.616,P=0.010]及血小板计数[(275.1 ±99.6)×109/L比(218.4±64.8)×109/L,t=2.948,P=0.006]上差异有统计学意义.症状侧颈内动脉系统(颈内动脉起始至大脑中动脉M1段)重度狭窄(≥70％)患者(23/79,29.1％)较轻中度狭窄(＜70％)患者(6/99,6.1％)MES阳性率高(x2=17.122,P=0.000).患者出院后平均随访时间为10.9个月(1～21个月).总计缺血性卒中复发9例,其中包括2例短暂性脑缺血发作.MES阳性患者卒中复发率17.2％(5/29),MES阴性患者卒中复发率2.7％ (4/149).通过卡普兰-迈耶分析发现MES阳性患者较MES阴性卒中复发风险高(log rank=10.610,P=0.001).应用COX回归校正年龄、卒中危险因素(高血压病、糖尿病、冠心病、吸烟、饮酒)、既往脑梗死病史、出院后服用药物规律性及NIHSS评分等因素后,仍显示MES阳性患者较MES阴性患者更容易卒中复发(RR =8.317,95％ CI1.937 ～ 35.717,P=0.004).结论在LAA型脑梗死患者中MES与血小板数量及血管狭窄程度相关.MES阳性患者较MES阴性患者卒中复发率明显增高;MES是LAA型脑梗死患者卒中复发的独立危险因素,但需增加样本数量,进一步验证该结论.
목적 미전자신호(MES)제시가능존재불은정반괴,유근기결혈성졸중복발가능.본문지재탐토대동맥죽양경화(LAA)형뇌경사환자MES양성솔급영향인소,이급MES여결혈성졸중복발적관계.방법 련속납입178례경내동맥계통LAA형뇌경사환자,소유환자행MES감측병정기수방관찰.통계분석MES양성솔급기영향인소,병진일보분석MES양성급음성환자졸중복발적비례화풍험.결과 178례LAA형뇌경사환자중유29례MES양성(16.3％).MES양성조여음성조환자재고밀도지단백[(0.949 ±0.204) mmol/L비(1.066±0.225) mmol/L,t=2.616,P=0.010]급혈소판계수[(275.1 ±99.6)×109/L비(218.4±64.8)×109/L,t=2.948,P=0.006]상차이유통계학의의.증상측경내동맥계통(경내동맥기시지대뇌중동맥M1단)중도협착(≥70％)환자(23/79,29.1％)교경중도협착(＜70％)환자(6/99,6.1％)MES양성솔고(x2=17.122,P=0.000).환자출원후평균수방시간위10.9개월(1～21개월).총계결혈성졸중복발9례,기중포괄2례단잠성뇌결혈발작.MES양성환자졸중복발솔17.2％(5/29),MES음성환자졸중복발솔2.7％ (4/149).통과잡보란-매야분석발현MES양성환자교MES음성졸중복발풍험고(log rank=10.610,P=0.001).응용COX회귀교정년령、졸중위험인소(고혈압병、당뇨병、관심병、흡연、음주)、기왕뇌경사병사、출원후복용약물규률성급NIHSS평분등인소후,잉현시MES양성환자교MES음성환자경용역졸중복발(RR =8.317,95％ CI1.937 ～ 35.717,P=0.004).결론 재LAA형뇌경사환자중MES여혈소판수량급혈관협착정도상관.MES양성환자교MES음성환자졸중복발솔명현증고;MES시LAA형뇌경사환자졸중복발적독립위험인소,단수증가양본수량,진일보험증해결론.
Objective Microembolic signals (MES) detected by transcranial Doppler (TCD) in patients with large artery atherosclerosis (LAA) ischemic stroke may associate with increased risk of early stroke recurrence because of unstable plague.The purpose of this study was to explore the prevalence of MES,analyze the influencing factors of the MES rate and the relationship between MES and ischemic stroke recurrence.Methods We consecutively included 178 patients with large artery atherosclerotic cerebral infarction in the internal carotid artery cerebral artery regions and detected them for MES.All patients were followed up for ischemic events recurrence.Prevalence of MES,factors related to the MES rate and the association between MES and stroke recurrence factors were analyzed.Results MES were detected in 29 (16.3％) of the 178 patients.Between the MES positive and negative groups,high-density lipoprotein ((0.949 ± 0.204) mmol/L vs (1.066 ± 0.225) mmol/L,t =2.616,P =0.01 0) and the number of plaelet ((275.1 ±99.6) × 109/L vs (218.4 ±64.8) × 109/L,t =2.948,P =0.006) were significantly different.The presence of MES was more frequent in patients with large severe stenosis artery (23/79,29.1％) than those with mild-moderate stenosis artery (6/99,6.1％ ; x2 =17.122,P =0.000).During follow-up for a mean of 10.9 months (range,1 to 21),9 patients experienced recurrent ipsilateral ischemic events including 2 transient ischemic attack.The rate of recurrence was 17.2％ (5/29) vs 2.7％ (4/149) between the MES positive and negative groups.The presence of MES predicted ischemic events recurrence (log rank =10.610,P =0.001) by Kaplan-Meier analysis.This remained significant(RR =8.317,95％ CI 1.937-35.717,P =0.004)after Cox regression was used to control for age,hypertension,diabetes,coronary heart disease,smoking,drinking,history of stroke,the regularity of drugs and NIHSS score.Conclusions The presence of MES associates with the number of platelet and the degree of large artery severe stenosis.MES can be a significant independent predictor of ischemic events recurrence in patients with large artery atherosclerotic cerebral infarction.But we need to verify the conclusion with large sample studies.