2023 年第 7 期 第 18 卷

青年与中老年脑梗死患者病因分析及右心声学造影在评估高风险卵圆孔未闭中的作用

Etiological analysis of young and middle-aged and elderly patients with cerebral infarction and the role of right heart contrast echocardiography in evaluating high-risk patent foramen ovale

作者：杨梅1刘金凤2张纯2

英文作者：Yang Mei1 Liu Jinfeng2 Zhang Chun2

单位：1山西省运城第一医院超声诊断科，运城044000；2首都医科大学附属北京安贞医院介入超声科，北京100029

英文单位：1Department of Ultrasound Yuncheng First Hospital of Shanxi Province Yuncheng 044000 China; 2Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：脑梗死；右心声学造影；卵圆孔未闭；颈动脉彩色多普勒超声

英文关键词：Cerebralinfarction;Rightheartcontrastechocardiography;Patentforamenovale;CarotidarterycolorDopplerultrasound

• 摘要：

• 目的  分析青年与中老年脑梗死患者的病因，评价右心声学造影在评估高风险卵圆孔未闭（PFO）中的作用。方法  收集2021年10月至2022年6月首都医科大学附属北京安贞医院住院的204例脑梗死患者的临床资料行回顾性分析。按照患者的年龄分为青年组（≤45岁，70例）和中老年组（＞45岁，134例）。比较2组的脑梗死相关因素、脑梗死的主要病因分类，分析右心声学造影对不同风险PFO的评估作用及PFO阳性患者脑梗死相关与不相关组差异因素。结果  中老年组美国国立卫生研究院卒中量表评分高于青年组，差异有统计学意义（P<0.05）。中老年组收缩压、PFO阳性、颅脑磁共振血管成像血管中-重度狭窄、颈动脉超声血管中-重度狭窄比例均高于青年组，差异均有统计学意义（均P＜0.05）。本研究针对美国国立卫生研究院卒中量表评分>0分的123例脑梗死患者进行病因分析，其中青年组（23例）血管病变2例（8.7%）、PFO 7例（30.4%）、其他原因14例（60.9%），PFO和其他原因是脑梗死主要病因；中老年组（100例）血管病变42例（42.0%）、PFO 38例（38.0%）、其他原因20例（20.0%），血管病变是脑梗死主要病因。右心声学造影阳性的青年脑梗死患者有血管病变范围小的特征，在评估高风险PFO方面有积极作用。PFO阳性患者中脑梗死相关组血糖高于脑梗死不相关组［（5.6±1.4）mmol/L比（4.9±0.9）mmol/L］，差异有统计学意义（P<0.05）。结论  PFO和其他原因是青年组脑梗死患者的主要病因，血管病变是中老年组脑梗死患者的主要病因。血糖水平高者脑梗死与PFO阳性相关。右心声学造影在评估高风险PFO方面有积极作用。

• Objective  To analyze the etiology of young and middle-aged and elderly patients with cerebral infarction and evaluate the role of right heart contrast echocardiography in evaluating high-risk patent foramen ovale(PFO). Methods  Chinical data of 204 patients with cerebral infarction admitted to Beijing Anzhen Hospital, Capital Medical University from October 2021 to June 2022 were collected retrospectively. They were divided into young group(≤45 years old, 70 cases) and middle-aged and elderly group(>45 years old, 134 cases) according to the age of the patients. The factors related to cerebral infarction and the main etiological classification of cerebral infarction between the two groups were compared. The evaluation effect of right heart contrast echocardiography on different risk PFO and the difference factors PFO positive patients between cerebral infarction related and unrelated group were analyzed. Results  The National Institutes of Health Stroke Scale score in the middle-aged and elderly group was higher than that in the young group(P<0.05). The systolic blood pressure, proportions of PFO positive, moderate to severe stenosis of brain magnetic resonance angiography vessels, and moderate to severe stenosis of carotid artery ultrasound vessels in the middle-aged and elderly group were higher than those in the young group (all P<0.05). This study analyzed the etiology of 123 patients with cerebral infarction who scored>0 on the National Institutes of Health Stroke Scale. There were 2 cases (8.7%) of vascular disease, 7 cases (30.4%) of PFO, and 14 cases (60.9%) of other causes in the young group (23 cases), and PFO and other causes were the main causes of cerebral infarction. There were 42 cases (42.0%) of vascular disease, 38 cases (38.0%) of PFO and 20 cases (20.0%) of other causes in the middle-aged and elderly group (100 cases), and vascular disease was the main cause of cerebral infarction. Young patients with cerebral infarction with positive right heart contrast echocardiography have the characteristics of small vascular disease, which played a positive role in evaluating high-risk PFO. Among PFO positive patients, blood glucose in the cerebral infarction related group was higher than that in the cerebral infarction unrelated group［（5.6±1.4）mmol/L vs （4.9±0.9）mmol/L］(P<0.05). Conclusions    PFO and other causes are the main causes of cerebral infarction in the young group, and vascular disease is the main cause of cerebral infarction in the middle-aged and elderly group. Cerebral infarction in patients with high blood glucose level is associated with PFO positive. The right heart contrast echocardiography plays a positive role in evaluating the high-risk PFO.