基于c-TCD探讨隐源性卒中患者右向左分流量与神经功能缺损程度的相关性研究

Exploring correlation between right-to-left shunt volume and degree of neurological deficit in patients with cryptogenic stroke based on c-TCD

目的探讨对比增强经颅多普勒超声(c-TCD)检查对隐源性卒中(CS)患者合并右向左分流(RLS)的检出率,评估CS患者RLS分流量与神经功能缺损严重程度之间的相关性。方法选取2019年1月至2023年9月在贵州医科大学附属医院神经内科住院治疗的CS患者,并将其分为RLS阳性CS组、RLS阴性CS组,另选取RLS阳性非CS患者为RLS阳性非CS组,同期健康志愿者为正常对照组。对各组行c-TCD检查,对c-TCD检查阳性的患者行心脏超声检查。根据患者的临床特征及神经功能缺损评分分析各组患者的组内及组间差异。结果169例CS患者纳入本研究,其中RLS阳性82例(RLS阳性CS组),RLS阴性87例(RLS阴性CS组),RLS阳性非CS患者14例(RLS阳性非CS组),正常对照组46例。各组患者在性别、年龄、高血压史、糖尿病史、肥胖、高脂血症、吸烟史及饮酒史等方面比较,差异无统计学意义(P>0.05)。RLS阳性CS患者的美国国立卫生研究院卒中量表(NIHSS)评分高于RLS阴性患者,且神经功能缺损症状更重(P<0.05)。进一步研究发现,中、大量RLS阳性CS患者的神经功能缺损症状比少量RLS及RLS阴性的CS患者严重(P<0.05)。结论CS患者RLS分流量大小与神经功能缺损的严重程度有一定的相关性。

Objective To explore the detection rate of contrast-enhanced transcranial Doppler(c-TCD)in patients with cryptogenic stroke(CS)complicated with right to left shunt(RLS)and evaluate the correlation between RLS volume and the severity of neurological deficits in CS patients.Methods CS patients who were hospitalized in the Department of Neurology at the Affiliated Hospital of Guizhou Medical University from January 2019 to September 2023 were selected and divided into RLS positive-and RLS negative-CS groups.Additionally,RLS positive non CS patients were in the RLS positive non CS group,while healthy volunteers during the same period are in the normal control group.c-TCD examination was performed on each group.Cardiac ultrasonography was performed on the patients with positive c-TCD.According to the clinical characteristics and neurological deficit scores,the differences within and between groups were analyzed.Results The study recruited 169 CS patients(n=82,RLS-positive CS group;n=87,RLS-negative CS group),14 patients(RLS-positive non-CS group)and 46 individuals(normal control group).There were no statistically significant differences in gender,age,the histories of hypertension,diabetes mellitus,obesity,hyperlipidemia,smoking and drinking among the groups(P>0.05).NIHSS score of RLS-positive CS patients was higher than that of RLS-negative patients,and their symptoms of neurological deficit were more severe than that of RLS-negative patients(P<0.05).It was further found that the neurological deficit symptoms of CS patients with moderate and large RLS-positive amounts were more severe than those with small amounts of RLS and RLS-negative CS(P<0.05).Conclusion There is a certain correlation between RLS volumes and the severity of neurological deficit in CS patients.