心脏右向左分流相关隐源性脑卒中的临床及影像特点分析

Analysis on clinical and imaging characteristics of cryptogenic stroke related to right-to-left shunt

目的探讨心脏右向左分流(RLS)相关隐源性脑卒中(CS)患者的临床表现及影像学特征。方法回顾收集浙江医院2019年5月至2022年3月诊断为CS患者共147例,所有患者均完成对比增强经颅多普勒(c-TCD)超声检查,根据检查结果分为阳性组及阴性组。比较两组患者的年龄、个人史、既往史、临床表现、c-TCD是否提示大量RLS、影像学特征等。结果阳性组与阴性组在临床表现上差异不明显,但影像学特征中病灶侧别与病灶供血区分布差异有统计学意义(χ^(2)=7.573、5.356,P<0.05)。多因素Logistic回归分析显示病灶位于右侧及双侧、前后循环供血区均累及是RLS阳性的影响因素[OR(95%CI)=2.881(1.188~6.983)、3.869(1.416~10.571)、0.239(0.093~0.613),均P<0.05]。结论RLS相关CS临床表现多样且缺乏典型性。CS患者影像学上病灶同时累及前后循环、更多地出现在右侧大脑半球或同时累及双侧大脑半球提示可能与RLS相关。

Objective To investigate the clinical manifestations and imaging features of cryptogenic stroke(CS)patients with right-to-left shunt(RLS).Methods A total of 147 patients diagnosed as CS at Zhejiang Hospital from May 2019 to March 2022 were collected retrospectively.All patients completed contrast-enhanced transcranial Doppler(c-TCD)ultrasound examination,and were divided into positive and negative groups according to the examination results.The age,personal history,medical history,clinical manifestations,presence of significant RLS on c-TCD,and imaging features etc.were compared between the two groups.Results There were no significant differences in clinical manifestations between the positive and negative groups.However,there were significant differences in the distribution of lesion side and blood supply areas among the imaging features(χ^(2)=7.573,5.356;P<0.05).Multivariate Logistic regression analysis showed that lesions located on the right side and bilateral sides,and involving both anterior and posterior circulation supply areas were independent influencing factors for RLS[OR(95%CI)=2.881(1.188-6.983),3.869(1.416-10.571),0.239(0.093-0.613);all P<0.05].Conclusion Clinical manifestations of RLS-related CS are diverse and atypical.Imaging features of CS patients with lesions involving both anterior and posterior circulation supply areas,predominantly on the right hemisphere or both hemispheres,may suggest an association with RLS.