右向左分流与缺血性脑血管疾病的相关性研究

发布时间：2018-05-11 17:33

本文选题：右向左分流 + 缺血性卒中　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：通过研究缺血性脑卒中患者和无卒中的对照组患者右向左分流（right-to-left shunt,RLS）发生率的差别，以及综合分析脑卒中多种危险因素，探讨RLS是否为缺血性脑卒中的独立危险因素。方法：根据第四届全国脑血管会议修订的缺血性脑卒中诊断标准，连续收集2012年1月到2012年12月的缺血性卒中患者和无卒中的对照组患者。进行标准的脑血管病危险因素问卷调查，并行经颅多普勒超声（transcranial Doppler,TCD）、颈动脉超声、TCD发泡试验和头部MRI检查。283例缺血性脑卒中患者和118例对照组患者知情同意入组。按照TOAST分型标准将患者分为五种类型：大动脉粥样硬化性卒中（LAA）、小动脉闭塞性卒中或腔隙性卒中（SAA）、心源性栓塞（CE）、其他原因所致的缺血性卒中（SOE）和不明原因的缺血性卒中（SUE）。按RLS的严重程度分级：大量分流（＞30个微栓子信号）、中量分流（10-30个微栓子信号）、小量分流（＜10个微栓子信号）。比较卒中组和对照组PFO的发生率，并结合卒中的其他危险因素综合分析RLS是否为缺血性卒中的独立危险因素。结果： 283例脑卒中患者中有85例存在PFO，118例对照组患者中有26例存在PFO（发生率30.0%vs.22.0%，Χ2=2.67，，P=0.10），卒中多危险因素的回归分析显示OR=1.59，P=0.149，RLS不能确立为卒中的独立危险因素。 134例不明原因缺血性卒中患者中有45例存在PFO，发生率33.6%，与对照组相比P＜0.05，Χ2=4.14，PFO与不明原因卒中显著相关。对不明原因卒中组与对照组病例进行卒中多危险因素的回归分析，OR=2.18，95%CI1.05—4.51，P=0.036，PFO为不明原因性卒中的独立危险因素；大量分流和中量分流与不明原因缺血性卒中显著相关（OR=3.90，95%CI1.28—11.87，P=0.016及OR=3.35，95%CI1.01—11.07，P=0.048）。结论： RLS为不明原因卒中的独立影响因素。RLS分流量越大，发生不明原因性卒中的可能性越大。
[Abstract]:Objective: In order to explore whether RLS is an independent risk factor for ischemic stroke, we studied the difference in the incidence of right to left shunt (RLS) in ischemic stroke patients and the control group without stroke, and comprehensively analyzed various risk factors of stroke. Methods: According to the diagnostic criteria of ischemic stroke revised by the fourth National Cerebrovascular Conference, the patients with ischemic stroke and the control group with no stroke were collected from January 2012 to December 2012. A standard questionnaire survey on risk factors of cerebrovascular disease was conducted, followed by transcranial Doppler Doppler TCDD, carotid ultrasound TCD-foaming test and head MRI examination. According to TOAST classification criteria, patients were divided into five types: Atherosclerotic stroke, arteriole occlusive stroke or lacunar stroke, cardiac embolism, ischemic stroke caused by other causes (SOE) and unexplained ischemic stroke. According to the severity of RLS, a large amount of shunt (> 30 microemboli signal), a moderate shunt of 10-30 microemboli signals and a small shunt (< 10 microemboli signals) were classified. The incidence of PFO in stroke group and control group was compared and combined with other risk factors of stroke to analyze whether RLS was an independent risk factor for ischemic stroke. Results: Of the 283 stroke patients, 85 had PFOF in 118 control group (the incidence rate was 30.0vs.22.0. the risk factors of stroke were 0.10%). The regression analysis of multiple risk factors of stroke showed that OR1.59 / 0.149 RLS could not be established as an independent risk factor for stroke. Among 134 patients with unexplained ischemic stroke, 45 cases had PFOs (33.6%). Compared with the control group, there was a significant correlation between PFO and unexplained stroke (P < 0.05). The regression analysis of multiple risk factors of stroke in patients with unknown cause stroke and control group was carried out with OR2.1895: CI1.05-4.51P0. 036% PFO was the independent risk factor of unexplained stroke, and the significant correlation between large shunt and moderate shunt and unknown cause ischemic stroke was 1.28-11.87 P0. 016 and OR3. 35% 95CI1.01-11.07P0.048. Conclusion: RLS is the independent influencing factor of unexplained stroke. The larger the shunt volume of RLS, the greater the probability of unexplained stroke.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.31

【共引文献】