中风发作后48小时的微栓塞信号会在一周内导致新的缺血。

Microembolic signals at 48 hours after stroke onset contribute to new ischaemia within a week.

作者信息

Iguchi Y, Kimura K, Kobayashi K, Ueno Y, Shibazaki K, Inoue T

机构信息

Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan.

出版信息

J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):253-9. doi: 10.1136/jnnp.2007.123414. Epub 2007 Sep 10.

DOI:10.1136/jnnp.2007.123414

PMID:17846111

Abstract

BACKGROUND AND AIMS

We investigated whether new ischaemic lesions (NIL) on follow-up diffusion weighted magnetic resonance imaging (DWI) are associated with microembolic signals (MES) within 24 h or at 48 h after stroke onset.

METHODS

Patients had acute ischaemic stroke and were studied within 24 h of onset. Transcranial Doppler ultrasonography (TCD) was prospectively examined twice, within 24 h and at 48 h after onset. DWI was conducted twice, on admission and on day 7. NIL were defined as the presence of hyperintense lesions undetected on initial DWI.

RESULTS

125 patients were consecutively enrolled from November 2004 to March 2006. TCD detected MES in 49% within 24 h and in 29% at 48 h after onset. In 27 patients with small vessel disease, MES were found in 8 (30%) patients within 24 h and in 5 (19%) patients at 48 h after stroke onset. In contrast, in 20 patients with large vessel disease, 11 (55%) patients within 24 h and 7 (35%) at 48 h had MES. Follow-up DWI detected NIL in 28 of 125 patients (22%) and NIL were significantly more frequent in MES positive patients (42%) than in MES negative patients at 48 h (15%; p = 0.002). MES at 48 h (OR 3.9; 95% CI 1.5 to 10; p = 0.005), atrial fibrillation (OR 3.6; 95% CI 1.3 to 11; p = 0.013) and arterial lesions (OR 4.3; 95% CI 1.5 to 12; p = 0.007) represented independent factors for NIL.

CONCLUSION

The presence of MES at 48 h, atrial fibrillation and arterial lesions were associated with recurrence of cerebral ischaemia on DWI.

摘要

背景与目的

我们研究了随访的扩散加权磁共振成像（DWI）上的新发缺血性病变（NIL）是否与卒中发作后24小时内或48小时内的微栓子信号（MES）相关。

方法

患者患有急性缺血性卒中，在发病24小时内接受研究。经颅多普勒超声检查（TCD）在发病后24小时内和48小时进行前瞻性检查两次。DWI在入院时和第7天进行两次。NIL定义为初始DWI未检测到的高强度病变。

结果

2004年11月至2006年3月连续纳入125例患者。TCD在发病后24小时内检测到MES的比例为49%，48小时时为29%。在27例小血管病患者中，8例（30%）在发病后24小时内发现MES，5例（19%）在48小时时发现MES。相比之下，在20例大血管病患者中，11例（55%）在24小时内发现MES，7例（35%）在48小时时发现MES。随访DWI在125例患者中的28例（22%）检测到NIL，在48小时时，MES阳性患者中NIL的发生率（42%）显著高于MES阴性患者（15%；p = 0.002）。48小时时的MES（比值比3.9；95%可信区间1.5至10；p = 0.005）、心房颤动（比值比3.6；95%可信区间1.3至11；p = 0.013）和动脉病变（比值比4.3；95%可信区间1.5至12；p = 0.007）是NIL的独立因素。