c-TCD阳性的隐源性卒中的临床及影像学特点

doi:10.3969/j.issn.1673-5765.2017.08.006

摘要/Abstract

摘要：

目的分析经颅多普勒发泡试验（contrast-enhanced transcranial Doppler，c-TCD）阳性的隐源性卒中患者的临床特点及梗死灶影像特征。方法纳入我院2013年1月-2016年12月根据TOAST分型诊断为隐源性缺血性卒中的患者，根据c-TCD 结果分为阳性组（伴右向左分流）及阴性组（不伴右向左分流）。分析并比较两组人口学资料、脑血管病传统危险因素、梗死灶影像学等方面的特点。结果共纳入113例患者，其中阳性组60例，阴性组53例。经食管超声心动图（transesoph ageal echocardiography，TEE）及肺动脉计算机断层扫描（computed tomography，CT）血管造影，阳性组52例发现卵圆孔未闭（patent foramen ovale，PFO），1例发现房间隔缺损。阴性组对比阳性组，其年龄结构更大（P＜0.05），高血压病、高胆固醇血症、吸烟3项缺血性卒中相关危险因素更多见（P＜0.05）。阳性组与阴性组无明显传统危险因素的病例比较，差异有显著性（P＜0.01）；两组梗死病灶血管分布影像学比较，差异无显著性（P＞0.05）；阳性组梗死病灶好发于皮层/皮层下区域（P =0.004），而阴性组则好发于深部灰质区域（P =0.015）。结论 c -TCD阳性的隐源性卒中发病年龄更低，传统脑血管病危险因素（高血压病、高胆固醇血症、吸烟）更少，c-TCD阳性组梗死病灶相对c-TCD阴性组血管分布差异无显著性，但梗死病灶更好发于皮层/皮层下区域。

文章导读： 经颅多普勒发泡试验阳性的隐源性卒中发病年龄更低，传统脑血管病危险因素（高血压病、高胆固醇血症、吸烟）更少，其梗死灶影像学特征提示更好发于皮层/皮层下区域。

关键词: TCD发泡试验; 隐源性卒中; 卵圆孔未闭

Abstract:

Objective To analyze the clinic features and radiologic characteristics of cryptogenic stroke patients with positive contrast-enhanced transcranial Doppler (c-TCD) examination. Methods Subjects diagnosed as cryptogenic stroke by TOAST subtypes were recruited consecutively from patients who were hospitalized in our hospital between January 2013 and December 2016. Subjects were divided into two groups: c-TCD positive group (with right to left shunt) and c-TCD negative group(without right to left shunt). Demographic characteristics, common risk factors of cerebrovascular disease, radiologic features of infarct focus were analyzed and compared. Results A total of 113 subjects were enrolled, including 60 ones in c-TCD positive group and 53 ones in c-TCD negative group. Using transesophageal echocardiography (TEE) and computed tomography (CT) pulmonary angiography, 52 in c-TCD positive group were diagnosed with patent foramen ovale (PFO), and 1 was diagnosed with atrial septal defect. Compared to the c-TCD positive group, the negative group was older (P <0.05), and had more risk factors including blood hypertension, high hypercholesteremia, and smoking (P <0.05). The difference of cases with no traditional risk factors between c-TCD positive and negative groups was significant (P <0.01). The two groups showed no significant difference in responsible vessels (P >0.05). Infarct foci in c-TCD positive group were more likely to be in cortical or subcortical area (P =0.004), while in negative group, they were more likely to be in deep grey matter (P =0.015). Conclusion Cryptogenic stroke patients with c-TCD positive tended to be younger, with less traditional risk factors (blood hypertension, high hypercholesteremia and smoking). There were no significant differences in responsible vessels between c-TCD positive and negative groups. Infarct foci in c-TCD positive group were more likely to be in cortical or subcortical area.

Key words: Contrast-enhanced transcranial Doppler; Cryptogenic stroke; Patent foramen ovale

段景怡，陈蓓蓓. c-TCD阳性的隐源性卒中的临床及影像学特点[J]. 中国卒中杂志, 2017, 12(08): 686-690.

DUAN Jing-Yi, CHEN Bei-Bei. Clinical and Imaging Features of c-TCD Positive Cryptogenic Stroke[J]. Chinese Journal of Stroke, 2017, 12(08): 686-690.

参考文献

[1] TSAI C F，THOMAS B，SUDLOW C L.

Epidemiology of stroke and its subtypes in Chinese

vs white populations：a systematic review[J].

Neurology，2013，81（3）：264-272.

[2] GRYSIEWICZ R A，THOMAS K，PANDEY D K.

Epidemiology of ischemic and hemorrhagic stroke：

incidence，prevalence，mortality，and risk factors[J].

Neurol Clin，2008，26（4）：871-895.

[3] ADAMS H P J R，BENDIXEN B H，KAPPELE L

J，et al. Clasification of subtype of acute ischemic

stroke. Definitions for use in a multicenter clinical

trial. TOAST. Trial of Org 10 172 in Acute Stroke

Treatment[J]. Stroke，1993，24（1）：35-41.

[4] SHER K，SHAH S，KUMAR S. Etiologic patterns

of ischemic stroke in young adults[J]. J Coll

Physicians Surg Pak，2013，23（7）：472-475.

[5] SASTRY S，RIDING G，MORRIS J，et al. Young

Adult Myocardial Infarction and Ischemic Stroke：

the role of paradoxical embolism and thrombophilia

（The YAMIS Study）[J]. J Am Coll Cardiol，2006，

48（4）：686-691.

[6] TSIVGOULIS G，STAMBOULIS E，SHARNM

V K，et al. Safety of transcranial Doppler ’bubble

study’ for identification of right to left shunts：an

international multientre study[J]. J Neurol Neurosurg

Psychiatry，2011，82（11）：1206-1208.

[7] JAUSS M，ZANETTE E. Detection of right-to-left

shunt with ultrasound contrast agent and transcranial

Doppler sonography[J]. Cerebrovasc Dis，2000，10

（6）：490-496.

[8] THALER D E，RUTHAZER R，DI

ANGELANTONIO E，et al. Neuroimaging findings

in cryptogenic stroke patients with and without

patent foramen ovale[J]. Stroke，2013，44（3）：675-

680.

[9] MOJADIDI M K，ROBERTS S C，WINOKER J

S，et al. Accuracy of transcranial Doppler for the

diagnosis of intracardiac right-to-left shunt：a

bivariate meta-analysis of prospective studies[J].

JACC Cardiovasc Imaging，2014，7（3）：236-250.

[10] 瑶婧璠，张玉梅，王拥军，等. 卵圆孔未闭与隐源性

卒中的关系探讨[J]. 中国医刊，2014，49（10）：52-55.

[11] HARA H，VIRMANI R，LADICH E，et al. Patent

foramen ovale：current pathology，pathophysiology，

and clinical status[J]. J Am Coll Cardiol，2005，46

（9）：1768-1776.

[12] LAMY C，GIANNESINI C，ZUBER M，et al.

Clinical and imaging findings in cryptogenic stroke

patients with and without patent foramen ovale：the

PFO-ASA Study. Atiral Septal Aneurysm[J]. Stroke，

2002，33（3）：706-711.

[13] 郑华光，王伊龙，陈启东，等. 反常性栓塞风险量表

在合并卵圆孔未闭的隐源性卒中或短暂性脑缺血

发作患者中的应用[J]. 中国卒中杂志，2014，9（8）：

654-662.

[14] KATSANOS A H，PSALTOPOULOU T，

SERGENTANIS T N，et al. Transcranial Doppler

versus transthoracic echocardiography for the

detection of patent foramen ovale in patients with

cryptogenic cerebral ischemia：A systematic review

and diagnostic test accuracy meta-analysis[J]. Ann

Neurol，2016，79（4）：625-635.

[15] SANTAMARINA E，GONZÁLEZ-ALUJAS M T，

MUÑOZ V，et al. Stroke patients with cardiac atrial

septal abnormalities：differential infarct patterns on

DWI[J]. J Neuroimaging，2006，16（4）：334-340.