不明原因晕厥中的右向左分流：一项年龄和性别匹配的病例对照研究。
Right-to-left shunts in unexplained syncope: an age- and sex-matched case-control study.
作者信息
Liu Dong, Chen Keyan, Gong Jie, Huang Lin, Dong Xin, Wan Qi, Qin Xiaoxuan, Shi Jiaojiao, Zhang Lihong, Wang Zhaolu
机构信息
Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
出版信息
Quant Imaging Med Surg. 2022 Jul;12(7):3592-3602. doi: 10.21037/qims-21-1060.
BACKGROUND
Syncope is common, but there is no clear cause for half of the patients diagnosed with syncope. Although suspected, there is limited evidence that right-to-left shunt (RLS) is related to syncope. This matched case-control study investigated the association between RLS (exposure) and unexplained syncope (outcome).
METHODS
Consecutive unexplained syncope cases, together with age- and gender-matched controls who did not have syncope were recruited from 2009 to 2010 in the first affiliated hospital of Nanjing Medical University. A transcranial Doppler ultrasonography bubble test was applied for the ascertainment of RLS. The degree of RLS was categorized into grades 0 to 4 according to the number of microemboli, which were no shunt, <10 microbubbles (MB), 11-25 MB, >25 MB single spots pattern, and MB in a shower/curtain pattern, respectively. Cerebral small vessel diseases (SVD), including white matter hyperintensity, lacunes, and enlarged perivascular spaces, were rated on Magnetic resonance imaging. Conditional logistic regression was used to examine the association between RLS and unexplained syncope.
RESULTS
A total of 52 cases and 52 age- and gender-matched controls were recruited. Among the 52 cases, 4 patients had a history of migraine. Among the 104 participants, 68 had no RLS; 13, 4, 7, and 12 presented with <10, 11-25, >25, and shower/curtain MB, respectively. The incidence of any RLS (Grade 1-4) was 48.1% (25/52) in cases and 21.2% (11/52) in controls (P=0.004). Conditional logistic regression showed an association between RLS and unexplained syncope [odds ratio (OR) =1.988; 95% confidence interval (CI): 1.233 to 3.205; P=0.005] adjusting for SVD burden. Further analysis revealed a large OR between severe RLS (Grade 3-4) and unexplained syncope (OR =8.699; P=0.006). Furthermore, SVD burden was shown to be associated with syncope.
CONCLUSIONS
This matched case-control study showed a significant association between RLS and unexplained syncope, independent of cerebral SVD. Prospective studies are needed to confirm the causal relationship.
背景
晕厥很常见，但在半数被诊断为晕厥的患者中，病因并不明确。尽管存在怀疑，但右向左分流（RLS）与晕厥相关的证据有限。这项配对病例对照研究调查了RLS（暴露因素）与不明原因晕厥（结果）之间的关联。
方法
2009年至2010年期间，在南京医科大学第一附属医院招募了连续的不明原因晕厥病例，以及年龄和性别匹配的无晕厥对照者。采用经颅多普勒超声气泡试验来确定RLS。根据微栓子数量将RLS程度分为0至4级，分别为无分流、<10个微气泡（MB）、11 - 25个MB、>25个MB单点模式以及呈簇状/幕状的MB。通过磁共振成像对脑小血管疾病（SVD）进行评分，包括白质高信号、腔隙和血管周围间隙增宽。采用条件逻辑回归分析RLS与不明原因晕厥之间的关联。
结果
共招募了52例病例和52名年龄及性别匹配的对照者。在52例病例中，4例有偏头痛病史。在104名参与者中，68例无RLS；13例、4例、7例和12例分别表现为<10个、11 - 25个、>25个MB以及呈簇状/幕状的MB。病例组中任何RLS（1 - 4级）的发生率为48.1%（25/52），对照组为21.2%（11/52）（P = 0.004）。条件逻辑回归显示，在调整SVD负担后，RLS与不明原因晕厥之间存在关联[比值比（OR）= 1.988；95%置信区间（CI）：1.233至3.205；P = 0.005]。进一步分析显示，重度RLS（3 - 4级）与不明原因晕厥之间的OR值较大（OR = 8.699；P = 0.006）。此外，SVD负担与晕厥相关。
结论
这项配对病例对照研究表明，RLS与不明原因晕厥之间存在显著关联，且独立于脑SVD。需要进行前瞻性研究以证实因果关系。
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