| 摘要: |
| 目的 探究不明原因栓塞性脑卒中（ESUS）患者的栓塞原因及影像学和临床特征，分析其与大动脉粥样硬化及心源性栓塞导致的大血管闭塞急性缺血性脑卒中（AIS-LVO）患者的差异。方法 回顾性连续纳入2018年1月至2019年12月于我院急诊就诊的、多模态CT检查提示前循环AIS-LVO且行血管内治疗的患者127例，其中ESUS 29例、大动脉粥样硬化40例、心源性栓塞58例。比较3组患者的入院时美国国立卫生研究院卒中量表（NIHSS）评分和Glasgow昏迷量表（GCS）评分、核心梗死体积、缺血半暗带体积、Alberta脑卒中计划早期计算机断层扫描评分（ASPECTS）及低灌注强度比值（HIR）。采用多因素logistic回归模型评价影像学特征对ESUS与大动脉粥样硬化的鉴别价值。结果 ESUS、大动脉粥样硬化和心源性栓塞组前循环AIS-LVO患者的入院时NIHSS评分和GCS评分、核心梗死体积、ASPECTS及HIR差异均有统计学意义（P均<0.05）。两两比较结果显示，ESUS组入院时GCS评分低于大动脉粥样硬化组，核心梗死体积和HIR均大于大动脉粥样硬化组（P均<0.05）；大动脉粥样硬化组和心源性栓塞组之间入院时NIHSS评分和GCS评分、核心梗死体积、ASPECTS及HIR差异均有统计学意义（P均<0.05）；而ESUS组与心源性栓塞组之间入院时NIHSS评分和GCS评分、核心梗死体积、缺血半暗带体积、ASPECTS及HIR差异均无统计学意义（P均>0.05）。多因素logistic回归分析显示HIR对前循环AIS-LVO患者的病因为ESUS有独立预测价值（OR=9.757 0，95%CI 1.203 4~79.107 2，P=0.03）。结论 与大动脉粥样硬化AIS-LVO患者比较，ESUS患者的影像学特征与心源性栓塞AIS-LVO患者更为接近，提示大部分ESUS可能由心源性栓塞引起。HIR对前循环AIS-LVO的病因判断有一定指导价值。 |
| 关键词: 不明原因栓塞性脑卒中 颅内栓塞 大血管闭塞 大动脉粥样硬化 心源性栓塞 影像学特征 低灌注强度比值 |
| DOI：10.16781/j.0258-879x.2022.01.0029 |
| 投稿时间：2021-09-23 |
| 基金项目:上海市科学技术委员会医学引导项目（19411965600），上海市自然科学基金（21ZR1479300） |
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| Embolism causes and imaging characteristics of patients with embolic stroke of undetermined source |
| TIAN Bing1△,HOU Yu-xi1△,TIAN Xia1,WANG Tie-gong1,LIU Jian-min2,LU Jian-ping1* |
(1. Department of Radiology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the embolism causes, and the imaging and clinical characteristics of patients with embolic stroke of undetermined source (ESUS), and analyze the differences of acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by large artery atherosclerosis and cardioembolism.Methods A total of 127 patients, who were admitted to Department of Emergency of our hospital from Jan. 2018 to Dec. 2019 with anterior circulation AIS-LVO suggested by multimodal computed tomography (CT) and underwent endovascular treatment, were retrospectively included. Twenty-nine patients had ESUS, 40 had large artery atherosclerosis and 58 had cardioembolism. The scores of National Institutes of Health stroke scale (NIHSS) and Glasgow coma scale (GCS) on admission, the volumes of infarction core and ischemic penumbra, Alberta Stroke Program early computed tomography score (ASPECTS) and hypoperfusion intensity ratio (HIR) were compared among the 3 groups. Multivariate logistic regression model was used to evaluate the differential value of imaging features for ESUS and large artery atherosclerosis.Results There were significant differences in the NIHSS and GCS scores on admission, infarction core volume, ASPECTS and HIR between the ESUS, large artery atherosclerosis and cardioembolism groups (all P < 0.05). The results of multiple comparison showed that the GCS score on admission in the ESUS group was significantly lower than that in the large artery atherosclerosis group, and the infarction core volume and HIR were significantly higher than those in the large artery atherosclerosis group (all P < 0.05); there were significant differences in the NIHSS and GCS scores on admission, infarction core volume, ASPECTS and HIR between the large artery atherosclerosis group and cardioembolism group (all P < 0.05); while there were no significant differences in the NIHSS and GCS scores on admission, infarction core volume, ischemic penumbra volume, ASPECTS or HIR between the ESUS group and cardioembolism group (all P > 0.05). Multivariate logistic regression analysis showed that HIR had independent predictive value for ESUS in patients with anterior circulation AIS-LVO (odds ratio=9.757 0, 95% confidence interval 1.203 4-79.107 2, P=0.03).Conclusion Compared with the AIS-LVO caused by large artery atherosclerosis, the imaging characteristics of ESUS are more similar to those of AIS-LVO caused by cardioembolism, suggesting that most ESUS may be caused by cardioembolism. HIR has guiding value for the judgment of the etiology of anterior circulation AIS-LVO. |
| Key words: embolic stroke of undetermined source intracranial embolism large vessel occlusion large artery atherosclerosis cardioembolism imaging characteristics hypoperfusion intensity ratio |
