对比增强经颅多普勒对隐源性缺血性卒中和先兆性偏头痛患者与右向左分流不同分流量相关性的研究

The relation of cryptogenic ischemic stroke and migraine with aura patients with different right-to-left shunt volume by contrast enhanced transcranial Doppler

目的对隐源性缺血性卒中和先兆性偏头痛患者的右向左分流阳性率及分流量进行对比分析,研究二者之间右向左分流的特征及可能的发病机制。方法连续入组48例隐源性缺血性卒中患者、42例先兆性偏头痛患者、33例健康志愿者做为对照组,使用对比增强经颅多普勒诊断右向左分流,并根据分流量进行分级,对3组的右向左分流阳性率和不同分级进行统计学分析。结果先兆性偏头痛组(57.1%,24/42)和隐源性缺血性卒中组(60.4%,29/48)的右向左分流阳性率明显高于正常对照组(30.3%,10/33)(P=0.02,P=0.008),隐源性缺血性卒中的右向左分流大量分流阳性率(29.2%,14/48)明显高于正常对照组(9.1%,3/33)(P=0.029)。结论隐源性缺血性卒中和先兆性偏头痛与右向左分流明显相关,尤其是隐源性缺血性卒中患者的右向左分流的大量分流比率明显高于正常对照组。

Objective To investigate the feature of the shunt volume of right-to-left shunt(RLS)in cryptogenic ischemic stroke(CIS)and migraine with aura(MA)and to analyze the different pathogenesis of CIS and MA with RLS.Methods Forty-eight CIS patients and 42 MA patients from two case groups and 33 healthy volunteers from normal control group(NCG),using contrast enhanced transcranial doppler(cTCD)for diagnosing RLS and shunt volume grades,the positive rate of the three groups were analyzed.Results In the case groups,the positive rate of RLS was MA 57.1%(24/42)and CIS 60.4%(29/48),of which large shunt accounted for MA 16.7%(7/42)and CIS 29.2%(14/48).In the NCG,the positive rate of RLS was 30.3%(10/33),of which large shunt accounted for 9.1%(3/33).Comparison of the three groups of the total positive rate,the total positive rate of two case groups were higher than NCG(MA vs NCG,P=0.02),(CIS vs NCG,P=0.008).Large shunt rate in CIS group was significantly higher than NCG(P=0.029).Conclusion CIS and MA are significantly related to RLS.The large shunt rate of RLS in CIS patients was significantly higher than that in NCG.