摘要
目的探讨伴有右向左分流(RLS)的隐源性卒中(cryptogenic stroke,CS)的患者RLS与左心房增大(LAE)间的关系,进一步研究LAE与伴有RLS的CS患者卒中发生的关系。方法收集2016年5月—2022年12月在我院神经内科收治的211例CS患者(CS组)及211例非脑卒中患者(对照组)的一般资料和经胸超声心动图检查的各项心脏参数,采用经颅多普勒超声发泡实验检测患者是否伴发RLS及RLS的分流程度。CS组患者根据有无RLS分为CSRLS+组和CSRLS-组,对照组患者依据有无RLS分为对照组RLS+组和对照组RLS-组,CSRLS+组患者依据分流程度分为大分流组和小分流组。对CS组和对照组、CSRLS+组和CSRLS-组、大分流组和小分流组以及CSRLS+组和对照组RLS+组的相关指标进行比较,并通过多因素logistic回归分析伴有RLS的CS患者卒中发生的影响因素。结果CS组与对照组患者心脏参数指标比较差异均具有显著性(t=-10.65~-2.45,P<0.05)。CSRLS+组患者的左心房直径(LAD)、左心房短径、左心房长径及肺动脉收缩压(PASP)大于CSRLS-组(t=-7.82~-2.30,P<0.05),并且大分流组患者LAD显著大于小分流组(t=-2.39,P<0.05)。CSRLS+组与对照组RLS+组男性、吸烟史、饮酒史、高血压、糖尿病构成比及左心室舒张末期内径、左心室收缩末期内径、室间隔厚度、左心室后壁厚度、LAD、左心房长径、PASP差异有显著性(t=-9.80~11.42,P<0.05)。多因素logistic回归分析显示,LAD增大是伴有RLS的CS患者卒中发生的独立危险因素(P<0.05)。结论CS患者LAE可能与RLS的存在及分流程度有关,LAD增大可能与伴有RLS的CS患者卒中的发病有关。
Objective To investigate the association between right-to-left shunt(RLS)and left atrial enlargement(LAE)and in cryptogenic stroke(CS)patients with RLS,as well as the association between LAE and the onset of stroke in CS patients with RLS.Methods General information and cardiac parameters on transthoracic echocardiography were collected from 211 CS patients(CS group)and 211 non-stroke patients(control group)who were admitted to department of neurology of our hospital,from May 2016 to December 2022,and transcranial Doppler was used to determine the presence or absence of RLS and the degree of RLS.According to the presence or absence of RLS,the patients in the CS group were further divided into CSRLS-positive group and CSRLS-negative group,and the patients in the control group were further divided into RLS-positive control group and RLS-negative control group;according to the degree of RLS,the CSRLS-positive group was further divided into severe RLS group and mild RLS group.Related indicators were compared between the CS group and the control group,between the CSRLS-positive group and the CSRLS-negative group,between the severe RLS group and the mild RLS group,and between the CSRLS-positive group and the RLS-positive control group,and a multivariate logistic regression analysis was used to identify the influence factors for the onset of stroke in CS patients with RLS.Results There were significant differences in cardiac parameters between the CS group and the control group(t=-10.65--2.45,P<0.05).Compared with the CSRLS-negative group,the CSRLS-positive group had significantly greater left atrial diameter(LAD),left atrial short diameter,left atrial long diameter,and pulmonary artery systolic pressure(PASP)(t=-7.82--2.30,P<0.05),and the severe RLS group had a significantly larger LAD than the mild RLS group(t=-2.39,P<0.05).There were significant differences between the CSRLS-positive group and the RLS-positive control group in the proportions of patients with male sex,smoking history,drinking history,hypertension,and diabetes,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,interventricular septum,left ventricular posterior wall,LAD,left atrial long diameter,and PASP(t=-9.80-11.42,P<0.05).The multivariate logistic regression analysis showed that the increase in LAD was independently associated risk factor of onset of stroke in CS patients with RLS(P<0.05).Conclusion LAE might be associated with the presence and degree of RLS in CS patients,and the increase in LAD might be associated with the onset of stroke in CS patients with RLS.
作者
方乐
魏凌
赵洪芹
FANG Le;WEI Ling;ZHAO Hongqin(Department of Neurology,The Affiliated Hospital of Qingdao University,Qingdao 266035,China)
出处
《精准医学杂志》
2023年第4期356-359,364,共5页
Journal of Precision Medicine
基金
国家重点研发计划项目(2016YFC1307300)。
