伴右向左分流的急性脑梗死影像学特征与分流级别的关系

Relationship Between Shunt Grading and Imaging Features in Acute Cerebral Infarction with Right-to-Left Shunt

目的 探讨合并右向左分流的急性脑梗死患者影像学特征与分流级别的关系。资料与方法 回顾性收集2019年1月-2021年12月南昌大学第二附属医院697例急性脑梗死患者的临床及影像学资料,通过发泡试验将患者分为右向左分流阴性组443例与阳性组254例,比较两组人口统计学资料及影像学特征的差异,分析阳性组患者急性脑梗死的影像学特征与发泡试验分流量的关系。结果 两组高血压(OR=0.533,95%CI 0.380~0.748)、糖尿病(OR=0.649,95%CI 0.422~0.999)、脑梗死(OR=0.275,95%CI 0.136~0.555)差异有统计学意义(P均<0.05),性别、年龄、吸烟、高血脂、冠心病差异无统计学意义(P>0.05)。两组梗死累及区域和梗死灶差异有统计学意义(χ^(2)=53.957、4.219,P均<0.05),梗死部位差异无统计学意义(P>0.05)。合并发泡试验阳性的急性脑梗死患者,Ⅰ、Ⅱ级在影像学上主要表现为单侧前循环或后循环梗死,以深部、单发梗死多见,Ⅲ、Ⅳ级分流患者多见于双侧前循环合并后循环的多发梗死。结论 合并右向左分流的急性脑梗死影像学具有一定的特征,发泡试验诊断右向左分流的敏感度高,两者结合分析可以给临床提供一定指导。

Purpose To investigate the relationship between imaging characteristics and shunt grading in acute cerebralinfarction patients with right-to-left shunt.Materials and Methods The clinical and imaging data of 697 acute cerebral infarction patients who were hospitalized in the Second Affiliated Hospital of Nanchang University from January 2019 to December 2021 were collected,and the patients were divided into right-to-left shunt negative group(443 cases)and right-to-left shunt positive group(254 cases)according bubble test,compared the difference in demographic data and imaging characteristics between the two groups.In the shunt positive group,the imaging characteristics of the two groups of patients and their relationship with the shunt grade were analyzed.Results There were no statistical differences in gender,age,smoking,hyperlipidemia and history of coronary heart disease between the two groups(P>0.05),but there were statistical differences in the history of hypertension(OR=0.533,95%CI 0.380-0.748),diabetes(OR=0.649,95%CI 0.422-0.999)and cerebral infarction(OR=0.275,95%CI 0.136-0.555)(all P<0.05).The imaging characteristics of the two groups of patients showed that there were significant differences in the number of infarct foci(χ^(2)=53.957,4.219;both P<0.05),but there was nostatistical difference in the infarct location between the two groups(P>0.05).Among the patients with acute cerebral infarction combined with positive bubble test,the imaging manifestations of grading I and II patients were mainly unilateral anterior circulation or posterior circulation infarction,and deep and single infarction were more common.In patients with grading III and IV shunts,multiple infarcts with combined bilateral anterior and posterior circulations were more common.Conclusion The imaging manifestations of patients with acute cerebral infarction combined with right-to-left shunt have their own characteristics.Bubble test has high sensitivity in the diagnosis of right-to-left shunt.The comprehensive analysis can provide certain guidance for clinical practice.