Liu Chang, Shi Feina, Chen Zhicai, Yan Shenqiang, Ding Xinfa, Lou Min
Department of Neurology, School of Medicine, The 2nd Affiliated Hospital of Zhejiang University, Hangzhou, China.
Department of Radiology, School of Medicine, The 2nd Affiliated Hospital of Zhejiang University, Hangzhou, China.
Front Neurol. 2018 Feb 8;9:55. doi: 10.3389/fneur.2018.00055. eCollection 2018.
Previous studies demonstrated that cardioembolism (CE) was prone to develop hemorrhagic transformation (HT), whereas hyper-permeability of blood-brain barrier (BBB) might be one reason for the development of HT. We, thus, aimed to investigate whether the BBB permeability (BBBP) was higher in CE stroke than other stroke subtypes in acute ischemic stroke (AIS) patients.
This study was a retrospective review of prospectively collected clinical and imaging database of AIS patients who underwent CT perfusion. Hypoperfusion was defined as Tmax >6 s. The average relative permeability-surface area product (rPS), reflecting the BBBP, was calculated within the hypoperfusion region (rPS). CE was diagnosed according to the international Trial of Org 10172 in Acute Stroke Treatment criteria. Receiver operating characteristics (ROC) curve analysis was used to determine predictive value of rPS for CE. Logistic regression was used to identify independent predictors for CE.
A total of 187 patients were included in the final analysis [median age, 73 (61-80) years; 75 (40.1%) females; median baseline National Institutes of Health Stroke Scale score, 12 (7-16)]. Median rPS was 65.5 (35.8-110.1)%. Ninety-seven (51.9%) patients were diagnosed as CE. ROC analysis revealed that the optimal rPS threshold for CE was 86.71%. The value of rPS and the rate of rPS>86.71% were significantly higher in patients with CE than other stroke subtypes ( < 0.05), after adjusting for the potential confounds.
The extent of BBB disruption is more severe in CE stroke than other stroke subtypes during the hyperacute stage.
既往研究表明，心源性栓塞（CE）易于发生出血性转化（HT），而血脑屏障（BBB）的高通透性可能是HT发生的原因之一。因此，我们旨在研究急性缺血性卒中（AIS）患者中，CE性卒中患者的BBB通透性（BBBP）是否高于其他卒中亚型。
本研究是对前瞻性收集的接受CT灌注的AIS患者的临床和影像数据库进行的回顾性分析。灌注不足定义为Tmax>6秒。在灌注不足区域（rPS）计算反映BBBP的平均相对通透表面积乘积（rPS）。根据国际急性卒中治疗奥扎格雷钠试验标准诊断CE。采用受试者工作特征（ROC）曲线分析确定rPS对CE的预测价值。采用逻辑回归确定CE的独立预测因素。
最终分析共纳入187例患者[中位年龄，73（61 - 80）岁；75例（40.1%）为女性；基线美国国立卫生研究院卒中量表评分中位数为12（7 - 16）]。rPS中位数为65.5（35.8 - 110.1）%。97例（51.9%）患者被诊断为CE。ROC分析显示，CE的最佳rPS阈值为86.71%。在调整潜在混杂因素后，CE患者的rPS值和rPS>86.71%的比例显著高于其他卒中亚型（<0.05）。
在超急性期，CE性卒中的BBB破坏程度比其他卒中亚型更严重。
