左房与左室增大在急性脑梗死CISS分型中的意义探讨

The significance of left atrial and ventricular enlargement in CISS classification of acute cerebral infarction

目的探讨左房、左室增大在急性脑梗死患者中国缺血性卒中亚型(CISS)分型中的意义。方法选择头颅CT或MRI证实存在急性脑梗死患者214例,收集相关临床资料,完善脑血管检查、心脏彩超等,采集相关数据进行统计学分析。结果心脏彩超示,大动脉粥样硬化性脑梗死(LAA)组、穿支动脉疾病性脑梗死(PAD)组左房前后径(LAD)、左房内径指数(LADI)均较心源性脑栓塞(CS)组低(P<0.05),但左室射血分数(LVEF%)均较CS组高(P<0.05);PAD组左室舒张末内径(LVEDD)低于CS组(P<0.05);LAA组左室舒张末期室间隔厚度(IVSD)、左心室质量指数(LVMI)均较PAD组高(P<0.05)。在左房肥大、左室肥厚发生率的组间对比中,χ_(左房)~2=13.446,P=0.001;χ_(左室)~2=5.323,P=0.073。3组左房肥大发生率差异有统计学意义(P<0.05),其中以CS组(40%)最高,LAA组(5%)次之。多因素Logistic分析显示,LADI在CS组中差异有统计学意义(P<0.01),LVMI在LAA、PAD组中差异有统计学意义(P<0.05)。结论左房增大、左心功能的下降与CS的发生密切相关,且左房增大为CS的独立危险因素。在非心源性栓塞的急性脑梗死中,左室增大更倾向于LAA,且左室增大为LAA、PDA的独立危险因素。

Objective To investigate the significance of left atrial and ventricular enlargement in CISS classification of acute cerebral infarction. Methods A total of 214 acute cerebral infarction cases certified by head CT or MRI were recruited in this stud y. All patients received complete cerebral vascular examination and cardiac color ultrasound, and the clinical information was col- lected for statistical analysis. Results In the comparison of cardiac color uhrasound indicators, the LAD and LADI from LAA and PAD groups were lower than CS group （P^0.05） ,but the LVEF~ was higher （P〈0. 05） ;LVEDD in PAD group was lower than CS group （P〈0. 05） ;the IVSD and LVMI in LAA group were higher than those in PAD group （P〈0. 05）. In the compari- son of left atrial （X2 =]3. 446,P=0. 001） and left ventricular （X2 =5. 323,P=0. 073） hypertrophy incidences among groups,the incident rate of left atrial hypertrophy had statistical significance among three groups （P〈0.05）, and the highest hypertrophy was found in CS group （40%） followed by LAA group （5%. In the nmlti-factor logistic analysis, LADI was statistically significant in CS group （P〈0.01） ,and LVMI was statistically significant in LAA and PAD groups （P〈0.05）. Conclusion Left atrial enlarge ment and the left cardiac function reduction are closely related to the incidence of CS,and the enlargement is the independent risk factor of CS. In acute cerebral infarction induced by non-cardiogenic embolism,left atrial enlargement indicates a higher possibility of LAA,which is the independent risk factor of LAA and PDA.