微栓子信号与LAA型脑梗死患者复发卒中的相关性研究
Analyze correlation detecting microembolic signals on transcranial Doppler in patients with large artery atherosclerotic cerebral infarction and ischemic stroke recurrence
目的:探讨微栓子信号(MES)在大动脉粥样硬化(LAA)型脑梗死患者中的表达及影响因素,分析MES与卒中复发的关系。方法选取2012年10月至2014年2月收治山西省运城市中心医院的267例LAA型脑梗死患者,均行MES监测,并定期进行随访观察。分析MES的影响因素及其阳性组、阴性组患者复发卒中的比例和风险。结果 LAA型脑梗死患者中MES阳性占16.5%(44/267)。MES阳性组高密度脂蛋白(HDL)和血小板计数为(0.94±0.21)mmol/L、(275.2±99.5)×109/L,MES阴性组相应指标为(1.06±0.24) mmol/L、(218.5±64.7)×109/L,对比差异有统计学意义(P<0.05)。病灶侧颈内动脉系统重度狭窄患者的MES阳性率29.7%明显高于轻中度狭窄患者6.0%,差异有统计学意义(P<0.001)。MES阴性患者卒中复发率为2.7%(6/223),MES阳性患者卒中复发率为18.2%(8/44),根据卡普兰-迈耶分析发现MES阴性卒中复发风险低于MES阳性患者(Log-rank=10.609,P=0.001)。采用Cox回归法分析卒中复发危险因素发现与MES阴性组相比,MES阳性组患者复发卒中的风险更高(RR=8.332,95%CI:1.945~35.695,P=0.003)。结论微栓子信号作为LAA型脑梗死患者复发卒中的一个独立危险因素, MES阳性患者卒中复发率明显高于MES阴性患者;MES与血管的狭窄程度及血小板计数相关联。
更多ObjectiveAnalyze the prevalence of MES in the large artery atherosclerosis, and the influence factors of the MES rate and the relationship between MES and ischemic stroke recurrence. Methods A total of 267 patients with LAA cerebral infarction were selected from October 2012 to February 2014 in Yuncheng Central Hospital, all use MES monitoring, and regular follow-up observation. Analysis of the influencing factors of MES and the proportion and risk of recurrent stroke in patients with positive and negative groups.Results MES positive rate was 16.5% (44/267) in patients with type LAA cerebral infarction.MES positive group of high density lipoprotein (HDL) and platelet count ( 0.94±0.21) mmol/L, (275.2±99.5)×109/L, MES negative group corresponding index for (1.06±0.24) mmol/L, (218.5±64.7)×109/L, this difference was statistically significant (P<0.05). The presence of MES was more frequent in patients with large severe stenosis artery (29.7%) than those with mild-moderate stenosis artery (6.0%), this difference was statistically significant (P<0.001). The rate of recurrence was 18.2% (8/44) vs 2.7% (6/223) between the MES positive and negative groups. The presence of MES predicted ischemic events recurrence (Log-rank=10.609,P=0.001) by Kaplan-Meier analysis. This remained significant (RR=8.332, 95%CI:1.945 - 35.695,P=0.003 ) after Cox regression was used to control for influencing factors. Conclusion MES can be a significant independent predictor of ischemic events recurrence in patients with large artery atherosclerotic cerebral infarction.The presence of MES associates with the number of platelet and the degree of large artery severe stenosis.
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