脑梗死累及岛叶预示心源性栓塞性卒中风险

Insular involvement after cerebral infarction predicts the risk of cardioembolic stroke

目的 探讨在大脑中动脉供血区脑梗死患者中,病灶累及岛叶是否与心源性栓塞性卒中存在相关性。方法 回顾性纳入2020年10月至2023年3月中山大学附属第一医院和广西医科大学第一附属医院卒中中心收治的发病7 d内的大脑中动脉供血区脑梗死患者。卒中病因分型分为心源性栓塞型和非心源性栓塞型。病灶是否累及岛叶主要通过磁共振弥散加权成像(DWI)进行确诊。采用单因素和多因素logistic回归分析探讨累及岛叶的脑梗死与心源性栓塞性卒中之间的相关性。结果 共纳入大脑中动脉供血区脑梗死患者1585例,其中心源性栓塞型173例(10.9%)和非心源性栓塞型1412例(89.1%)。脑梗死累及岛叶448例(28.3%),其中心源性栓塞组135例(78.0%)和非心源性栓塞组313例(22.2%)。单因素logistic回归分析提示累及岛叶的脑梗死与心源性栓塞性卒中存在相关性(未调整模型:OR=12.474, 95%CI 8.520~18.263,P<0.001)。在调整潜在混杂因素后,两者间仍存在显著相关性(模型3:OR=6.233, 95%CI 3.688~10.543;P<0.001)。此外,累及左侧(模型3:OR=4.977, 95%CI 2.757~8.987,P<0.001)和右侧岛叶的脑梗死(模型3:OR=4.998,95%CI 2.743~9.107,P<0.001)均与心源性栓塞性卒中存在相关性。结论 大脑中动脉供血区脑梗死累及岛叶可作为心源性栓塞性卒中的潜在影像学标志。

Objective To determine whether insular involvement was associated with cardioembolic stroke(CES)in patients with middle cerebral artery(MCA)infarction.Methods The patients with MCA infarction admitted to stroke centers of the First Affiliated Hospital,Sun Yat-sen University,and the First Affiliated Hospital of Guangxi Medical University,from October 2020 to March 2023 were included retrospectively.Stroke etiologies were classified into cardioembolic and noncardioembolic subtypes.Insular involvement was determined mainly using diffusion-weighted magnetic resonance imaging(DWI).Univariate and multivariate logistic regression analyses were performed to evaluate the association between insular involvement and CES.Results Of 1585 patients enrolled,stroke etiologies were cardioembolic subtype in 173(10.9%)and noncardioembolic subtype in 1412(89.1%).Insular involvement was found in 448 cases(28.3%).Among these cases,135(78.0%)were found in the cardioembolic group,and 313(22.2%)in the noncardioembolic group.Univariate analysis demonstrated that insular involvement was associated with CES(unadjusted odds ratio[OR],12.474;95%confidence interval[CI],8.520~18.263,P<0.001).After adjusting for potential confounders,this association remained significant(model 3:OR,6.233;95%CI,3.688~10.534,P<0.001).Such associations were also observed in patients with left(model 3:OR,4.977;95%CI 2.758~8.987,P<0.001)or right insular involvement(model 3:OR,4.998;95%CI 2.743~9.107,P<0.001).Conclusions Insular involvement after MCA infarction may be a potential neuroimaging biomarker of CES.