Department of Neurology, Lianyungang Second Hospital, Lianyungang, Jiangsu 222006, P.R. China.
Mol Med Rep. 2013 Oct;8(4):1135-42. doi: 10.3892/mmr.2013.1609. Epub 2013 Aug 1.
The aim of the present study was to investigate the effects of microembolic signals (MES) on post‑stroke neurological deficits, stroke recurrence and survival in patients with acute cerebral infarction (CI). Patients with acute CI were enrolled consecutively and classified etiologically into the following 4 subtypes using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification: i) Cardioembolism (CE); ii) large‑artery atherosclerosis (LA); iii) small‑vessel disease (SVD); and iv) stroke of other etiology, including other and undetermined etiologies. The MES of cerebral arteries were monitored by transcranial doppler (TCD), carotid atherosclerotic lesions were detected by color Doppler sonography and extracranial and intracranial magnetic resonance angiography were performed. Next, the severity of neurological deficits was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores. Cases of stroke recurrence and post‑stroke mortality were recorded. A total of 135 patients were recruited, including 33 with CE, 49 with LA, 24 with SVD and 29 with stroke of other etiology. A significant difference in the incidence of MES was identified between the 4 subtypes (P=0.025). The occurrence of positive MES was found to markedly correlate with a history of coronary heart disease (P<0.001) and antithrombotic treatment (P=0.045) and increased levels low density lipoprotein (P=0.036). Compared with patients with negative MES, no significant changes in NIHSS scores were found in patients with positive MES on days 1 and 7 following admission. The incidence of recurrent stoke and post‑stroke mortality was elevated 3 months from the onset of CI. In conclusion, a significant difference in the occurrence of MES was identified between subtypes of patients with acute CI. The incidence of recurrent stroke and mortality was increased among patients with positive MES 3 months from onset.
本研究旨在探讨微栓子信号（MES）对急性脑梗死（CI）患者卒中后神经功能缺损、卒中复发和生存的影响。连续纳入急性 CI 患者，并采用 Trial of Org 10172 in Acute Stroke Treatment（TOAST）分类将其病因学分类为以下 4 个亚型：i）心源性栓塞（CE）；ii）大动脉粥样硬化（LA）；iii）小血管疾病（SVD）；iv）其他病因引起的卒中，包括其他和未确定的病因。通过经颅多普勒（TCD）监测脑动脉的 MES，通过彩色多普勒超声检测颈动脉粥样硬化病变，并进行颅外和颅内磁共振血管造影。然后，使用国立卫生研究院卒中量表（NIHSS）评分评估神经功能缺损的严重程度。记录卒中复发和卒中后死亡率的病例。共纳入 135 例患者，其中 33 例为 CE，49 例为 LA，24 例为 SVD，29 例为其他病因引起的卒中。4 个亚型之间 MES 的发生率存在显著差异（P=0.025）。阳性 MES 的发生与冠心病史（P<0.001）和抗血栓治疗（P=0.045）以及低密度脂蛋白水平升高显著相关（P=0.036）。与 MES 阴性患者相比，入院第 1 天和第 7 天 MES 阳性患者的 NIHSS 评分无明显变化。CI 发病后 3 个月，卒中复发和卒中后死亡率升高。总之，急性 CI 患者各亚型之间 MES 的发生率存在显著差异。MES 阳性患者的卒中复发和死亡率在发病后 3 个月升高。
