微栓子信号的发生率及其临床意义

Incidence rate and clinical significance of intracranial microembolic signals

目的探讨常规接受微栓子监测检查患者的微栓子信号发生率以及其相关临床特征。方法连续纳入自2016年7月至2018年12月接受常规30 min微栓子监测以及常规TCD检查中探及到微栓子信号的患者,收集基线信息。结果共5886例患者进行了30 min微栓子监测检查,其中50例存在微栓子信号,阳性率0.85%。大脑中动脉微栓子信号的出现率最高,达84%。46%(23/50)微栓子来源于动脉,包括8例动脉粥样硬化性脑动脉或颈动脉狭窄、10例颅内动脉、4例烟雾病和1例ANCA相关性动脉炎;30%(15/50)提示心脏来源的微栓子,包括1例心房颤动、4例人造瓣膜和10例卵圆孔未闭;其他原因微栓子来源占24%(12/50),包括8例从右到左分流和4例未知来源。微栓子阳性的患者脑白质病变及认知障碍发生率高,分别为72%及68%。结论微栓子信号较罕见,不同的疾病微栓子信号的临床意义及机制可能不一样。

Objective To investigate the incidence rate and related clinical features of microembolic signals(MES)in patients receiving routine transcranial Doppler examinations for microembolus monitoring.Methods From July 2016 to December 2018,the patients who received routine 30-minute MES monitoring and were detected to have MES were enrolled consecutively,and their baseline data were collected.Results A total of 5886 patients received routine 30-minute MES monitoring,and MES were detected in 50 patients,with a positive rate of 0.85%.MES of the middle cerebral artery had the highest detection rate of 84%.Among these 50 patients,23(46%)had microemboli originating from the artery,among whom 8 had atherosclerotic cerebral or carotid artery stenosis,10 had the involvement of intracranial arteries,4 had moyamoya disease,1 had and ANCA-related arteritis;15(30%)had microemboli originating from the heart,among whom 1 had atrial fibrillation,4 had artificial valves,and 10 had patent foramen ovale;12(24%)had microemboli from other sources,among whom 8 had right-to-left shunt and 4 had unknown origin.The patients with MES had high incidence rates of white matter lesions(72%)and cognitive impairment(68%).Conclusions MES is relatively uncommon and may have different clinical significance and mechanisms in different diseases.