隐源性缺血性脑卒中与房间隔膨胀瘤的相关性研究

Correlation between cryptogenic ischemic stroke and atrial septum dilatation tumor

目的探讨隐源性缺血性脑卒中(Cryptogenic ischemic stroke,CS)与房间隔膨胀瘤(Atrial septal aneurysm,ASA)的相关性。方法选取2015年1月-2020年1月本院神经内科收治的≤55周岁CS患者137例(观察组)及同时期的体检健康人群137例(对照组),比较2组年龄、性别、体质量指数、饮酒史、吸烟史、脑卒中家族史、左室射血分数、右房横径、右房上下径、左室舒张末期内径、高同型半胱氨酸血症、卵圆孔未闭、睡眠呼吸暂停综合征、颈动脉夹层、阵发性房颤、血小板减少性紫癜、偏头痛、动脉炎、ASA分布情况及ASA膨出度、基底直径,采用Logistic回归方程分析CS的相关影响因素,采用Pearson分析ASA膨出度、基底直径与美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分的相关性,分析合并ASA的CS患者年龄、性别、神经功能缺损程度分布特点。结果2组高同型半胱氨酸血症、卵圆孔未闭、睡眠呼吸暂停综合征、颈动脉夹层、阵发性房颤、血小板减少性紫癜、偏头痛、动脉炎、ASA分布比较均有明显差异(P<0.05);高同型半胱氨酸血症、卵圆孔未闭、睡眠呼吸暂停综合征、颈动脉夹层、阵发性房颤、血小板减少性紫癜、偏头痛、动脉炎、ASA均是CS的相关危险因素(P<0.05);观察组ASA膨出度、基底直径大于对照组(P<0.05);ASA膨出度、基底直径与NIHSS评分呈正相关(P<0.05);合并ASA的CS患者年龄41~50岁占比最高,为44.44%,其次是31~40岁(25.93%)、51~55岁(18.52%)、20~30岁(11.11%);男性占比55.56%,高于女性的44.44%;神经功能缺损程度以中度(59.26%)、重度(33.33%)为主。结论CS的发生与高同型半胱氨酸血症、卵圆孔未闭、睡眠呼吸暂停综合征、颈动脉夹层、阵发性房颤、血小板减少性紫癜、偏头痛、动脉炎、ASA有关,且ASA膨出度、基底直径可影响CS患者的神经功能缺损程度,CS伴ASA高发于41~50岁男性人群,以中重度病情为主。

Objective To investigate the correlation between cryptogenic ischemic stroke(CS) and atrial septal aneurysm(ASA). Methods 137 patients withCS(≤55 years old, observation group) and 137 healthy people(control group) admitted to the department of neurology were included in this study from January 2015 to January 2020.The age, gender, body mass index, drinking history, smoking history, family history of stroke, left ventricular ejection fraction, right atrium transverse diameter, right and left atrium diameter, left ventricular end-diastolic diameter, hyperhomocysteinemia, oval foramen, sleep apnea syndrome, carotid artery dissection, paroxysmal atrial fibrillation, thrombocytopenic purpura, migraine, arteritis, ASA distribution, ASA bulge and basal diameter of patients in the two groups were compared. Logistic regression equation was used to analyze the related influencing factors of CS.Pearson correlation analysiswas used to analyze the correlation between ASA bulge, basal diameter and National Institute of Health stroke scale(NIHSS) score, and the distribution characteristics of age, sex, and neurological deficits of CS patients with ASA were counted. Results There were statistically significant differences in the hyperhomocysteinemia, oval foramen, sleep apnea syndrome, carotid artery dissection, paroxysmal atrial fibrillation, thrombocytopenic purpura, migraine, arteritis, and the distribution of ASA between the two groups(P<0.05), hyperhomocysteinemia, foramen ovale, sleep apnea syndrome, carotid artery dissection, paroxysmal atrial fibrillation, thrombocytopenic purpura, migraine, arteritis, ASA were demonstrated to be the related risk factors of CS(P<0.05), the ASA bulge and base diameter of patients in the observation group were larger than that in the control group(P<0.05), the ASA bulge and base diameter were positively correlated with the NIHSS score(P<0.05). CS patients with ASA accounted for the highest proportion of 41 to 50 years old, 44.44%, followed by 31 to 40 years old(25.93%), 51 to 55 years old(18.52%), 20 to 30 years old(11.11%);men accounted for 55.56%, higher than women’s 44.44%;the degree of neurological deficit was mainly moderate(59.26%) and severe(33.33%). Conclusion The occurrence of CS was positively correlated withhyperhomocysteinemia, oval foramen, sleep apnea syndrome, carotid artery dissection, paroxysmal atrial fibrillation, thrombocytopenic purpura, migraine, arteritis, ASA. ASA bulge and basal diameter can affect the degree of neurological deficits in patients with CS. The high incidence of CS patients with ASA occurs in men aged 41 to 50, with moderate to severe disease.