心源性缺血性脑卒中的临床特征及危险因素分析

Analysis of Clinical Features and Risk Factors of Cardiogenic Ischemic Stroke

目的:分析心源性缺血性脑卒中的临床特征及危险因素。方法:选取广安市人民医院2019年11月—2022年11月收治的210例缺血性脑卒中病人。根据急性脑卒中Org10172试验(TOAST)分型将病人分为心源性脑卒中(42例)、大动脉粥样硬化性脑卒中(73例)、腔隙性脑卒中(66例)、不明原因脑卒中(29例),比较不同TOAST分型脑卒中病人超声心动图参数,分析心源性缺血性脑卒中影响因素,评价超声心动图参数联合D-二聚体对心源性缺血性脑卒中的诊断价值。结果:心源性缺血性脑卒中病人左心房内径(LAD)大于其他TOAST分型脑卒中病人,左室射血分数(LVEF)及每搏输出量(SV)均小于其他TOAST分型脑卒中病人,D-二聚体及N末端B型脑钠肽前体水平均高于其他TOAST分型脑卒中病人,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,D-二聚体、LAD及SV均是心源性缺血性脑卒中的影响因素(P<0.05);受试者工作特征(ROC)曲线显示,D-二聚体、LAD、SV诊断心源性缺血性脑卒中的曲线下面积(AUC)分别为0.737,0.751,0.711,截断值分别为291.32 ng/mL、37.57 mm、70.16 mL,三者联合诊断的AUC为0.853,敏感度、特异度分别为73.81%、91.07%。结论:心源性缺血性脑卒中病人LAD增大,LVEF及SV均降低;D-二聚体、LAD及SV均是心源性缺血性脑卒中的危险因素;LAD、SV联合D-二聚体对心源性缺血性脑卒中有一定诊断价值,可辅助心源性缺血性脑卒中病人的快速筛选。

Objective:To analyze the clinical features and risk factors of cardiogenic ischemic stroke.Methods:Two hundred and ten ischemic stroke patients admitted to Guang′an People′s Hospital from November 2019 to November 2022 were selected.According to TOAST classification,there were 42 cases diagnosed as cardiogenic stroke,73 cases as large atherosclerotic stroke,66 cases as lacunar stroke and 29 cases as unknown cause stroke.Echocardiographic parameters of stroke patients with different TOAST classification were compared to analyze the influencing factors of cardiogenic ischemic stroke.The diagnostic value of echocardiographic parameters combined with D-dimer in cardiogenic ischemic stroke was evaluated.Results:The left atrial diameter(LAD)of cardiogenic ischemic stroke patients was larger than that of other TOAST stroke patients,the left ventricular ejection fraction(LVEF)and stroke volume(SV)were smaller than those of other TOAST stroke patients,and the levels of D-dimer and N-terminal B-type natriuretic peptide precursors were higher than those of other TOAST stroke patients,the differences were statistically significant(P<0.05).Multiple Logistic regression analysis showed that D-dimer,LAD were the risk factors of cardiogenic ischemic stroke(P<0.05).Receiver operating characteristics(ROC)curves showed that the area under the curve(AUC)of D-dimer,LAD and SV in the diagnosis of cardiogenic ischemic stroke were 0.737,0.751,and 0.711 respectively,and the cutoff values were 291.32 ng/mL,37.57 mm,and 70.16 mL,respectively.The AUC of the combined diagnosis was 0.853,and the sensitivity and specificity were 73.81%and 91.07%respectively.Conclusion:The patients with cardiogenic ischemic stroke showed more LAD and less LVEF and SV.D-dimer,LAD,and SV were the risk factors for cardiogenic ischemic stroke.LAD and SV combined with D-dimer had certain diagnostic value for cardiogenic ischemic stroke,and could assist for the rapid screening of patients with cardiogenic ischemic stroke.