Iguchi Yasuyuki, Kimura Kazumi, Kobayashi Kazuto, Yamashita Shinji, Shibazaki Kensaku, Inoue Takeshi
Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.
J Neurol Sci. 2007 Dec 15;263(1-2):54-8. doi: 10.1016/j.jns.2007.05.030. Epub 2007 Jun 22.
Microembolic signals (MES) on transcranial Doppler ultrasonography (TCD) are occasionally detected in acute ischemic stroke patients and gradually decrease over time. If MES is detectable at 7 days after stroke onset, embolic source lesions may still be active. We hypothesized that presence of MES at 7 days after stroke onset is strongly associated with stroke recurrence.
Subjects comprised 143 patients with acute ischemic stroke who were prospectively examined for the presence of MES using TCD both within 24 h and at 7 days after stroke onset. Stroke recurrence was assessed within 3 months of stroke onset. The association between presence of MES and stroke recurrence was investigated.
MES was detected in 70 of 143 patients (49%) within 24 h of stroke onset and in 34 patients (24%) at 7 days. Stroke recurrence was observed in 6 patients after 7 days and in 10 patients between 7 days and 3 months after stroke onset. Presence of MES within 24 h of stroke was not associated with stroke recurrence (10% for MES-positive vs. 12% for MES-negative, p=0.792). At 7 days after onset, stroke recurrence was more frequent in the MES-positive group at 7 days than in the MES-negative group (24% vs. 7%, p<0.0001). Cox's proportional hazard analysis demonstrated presence of MES as an independent factor of stroke recurrence (hazard ratio, 6.4; 95% confidence interval, 1.4-28; p=0.015).
Presence of MES detected on TCD at 7 days of stroke onset should be a predictor of stroke recurrence.
经颅多普勒超声检查（TCD）发现的微栓子信号（MES）偶尔会在急性缺血性脑卒中患者中检测到，且会随时间逐渐减少。如果在卒中发病7天后仍可检测到MES，则栓子源病变可能仍处于活跃状态。我们推测卒中发病7天时MES的存在与卒中复发密切相关。
研究对象为143例急性缺血性脑卒中患者，前瞻性地在卒中发病24小时内及7天时使用TCD检测MES的存在情况。在卒中发病3个月内评估卒中复发情况。研究MES的存在与卒中复发之间的关联。
143例患者中，70例（49%）在卒中发病24小时内检测到MES，34例（24%）在7天时检测到MES。7天后有6例患者出现卒中复发，卒中发病7天至3个月之间有10例患者出现卒中复发。卒中发病24小时内MES的存在与卒中复发无关（MES阳性组为10%，MES阴性组为12%，p = 0.792）。发病7天时，MES阳性组的卒中复发比MES阴性组更频繁（24%对7%，p < 0.0001）。Cox比例风险分析表明，MES的存在是卒中复发的独立因素（风险比为6.4；95%置信区间为1.4 - 28；p = 0.015）。
卒中发病7天时TCD检测到MES的存在应可作为卒中复发的预测指标。
