微栓子阳性动脉硬化性脑梗死患者的临床特点以及微栓子的转归

摘要

Objective To compare the clinical characteristics of acute cerebral infarction patients with or without microembolic signal ( MES) and to investigate the prognosis of MES. Methods Acute cerebral infarction patients (within 7 days) were included into our study. Thirty minutes of transcranial doppler(TCD) monitoring for MES was performed on admission and on 7th day after admission. Diffusion weighted imagin ( DW1) was performed on admission to investigate the number of new infarctions. Clinical data including risk factors, NIHSS and drugs were recorded detailed. Results Thirty-one patients were enrolled into our study, among which 12 patients were found with MES. The NIHSS in patients with MES was found lower than that in patient without MES(3.83 ±3. 16 vs 7.00 ±3.93, P=0.026). The frequency of MES in female was found higher than that in male(6/12 vs 3/19, P =0.056). The age of patients with MES was younger than that of patients without MES(60. 17 ± 18.91 vs 68. 79 ± 11.44, P =0.174). The patients with MES was found with more frequency of multiple infarcts on DWI(6/12 vs 4/ 15, P =0. 093). The medium of MES number reduced significantly on day 7(8 vs 1, P =0.041) , among which 5 patients were found disappearance of MES on day 7. Conclusions The acute cerebral infarct patients with large artery stenosis and MES are younger than those without MES and the severity of stroke was not as severe as those without MES. Multiple infarets can be found much more frequently in patients with MES than those without MES. The MES maybe disappear as time goes by and may be due to the use of antiplatelet drugs.%目的 比较经颅多普勒微栓子监测有、无微栓子信号的颅内大动脉狭窄所致急性脑梗死患者的临床特点,观察微栓子信号的转归.方法 收集存在颅内大动脉狭窄的发病7 d内的急性脑梗死患者,在人院第1天和第7天进行经颅多普勒监测相应的狭窄动脉半小时以及磁共振弥散加权成像检查.确定有无微栓子信号,判断新发梗死灶的数目及分布.详细记录所有临床特点,美国国立卫生院神经功能缺损评分(NIHSS),用药情况.结果 共收集资料齐全的31例患者,其中12例患者存在微栓子信号.存在微栓子信号的患者NIHSS低于无微栓子信号的患者[(3.83±3.16)分比(7.00±3.93)分,P=0.026];平均年龄亦有低于无微栓子信号患者的倾向[(60.17±18.91)岁比(68.79±11.44)岁,P=0.174];女性患者存在微栓子信号的比例偏高(6/12比3/19,P=0.056);存在微栓子信号的患者磁共振弥散加权成像上存在多发性梗死灶的比例高(6/12比4/15,P=0.093).结论 存在微栓子信号的大动脉狭窄患者发生脑梗死的年龄偏早,而卒中严重程度相对较轻.存在微栓子信号的患者磁共振弥散加权成像上病灶多为多发性梗死.卒中发生后微栓子信号可能随时间延长和抗血小板药物的治疗而减少或消失.