2024 年第 4 期 第 19 卷

心脏黏液瘤相关缺血性脑卒中临床特点和危险因素的单中心队列研究

A single-center cohort study on the clinical characteristics and risk factors of ischemic stroke associated with cardiac myxoma

作者：乔曼丽1马立萍1李昆宇2吴阳娇3涂遵媚4舒珍珍5税春桃6

英文作者：Qiao Manli1 Ma Liping1 Li Kunyu2 Wu Yangjiao3 Tu Zunmei4 Shu Zhenzhen5 Shui Chuntao6

单位：1首都医科大学附属北京安贞医院全科医疗科，北京100029；2北京市房山区石楼镇社区卫生服务中心，北京102488；3贵州省遵义市务川县泥高卫生院，遵义564311；4贵州省仁怀市九仓镇卫生院，仁怀564509；5贵州省遵义市湄潭县兴隆镇卫生院，遵义564102；6贵州省遵义市赤水市元厚中心卫生院，遵义564709

英文单位：1Department of General Practice Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Community Health Service Center in Shilou Town Fangshan District Beijing 102488 China; 3Nigao Health Center in Wuchuan County Guizhou Province Zunyi 564311 China; 4Jiucang Town Health Center Guizhou Province Renhuai 564509 China; 5Xinglong Town Health Center in Meitan County Guizhou Province Zunyi 564102 China; 6Yuanhou Health Center in Chishui County Guizhou Province Zunyi 564709 China

关键词：心脏黏液瘤；缺血性脑卒中；心源性卒中

英文关键词：Cardiacmyxoma;Ischemicstroke;Cardiogenicstroke

• 摘要：

• 目的 探讨心脏黏液瘤相关缺血性脑卒中的临床特点和危险因素，为心脏黏液瘤相关缺血性脑卒中的早期识别和诊断提供依据。方法 回顾性收集2010年1月至2020年12月就诊于首都医科大学附属北京安贞医院的心脏黏液瘤患者408例。分析心脏黏液瘤患者和心脏黏液瘤相关缺血性脑卒中患者的临床表现，并分析心脏黏液瘤相关缺血性脑卒中的危险因素。结果 全部408例心脏黏液瘤患者中，396例纳入分析，其中包括48例心脏黏液瘤相关缺血性脑卒中患者和348例心脏黏液瘤非脑卒中患者。心脏黏液瘤的临床症状不典型，以心脏梗阻、栓塞和全身系统症状为主。在心脏黏液瘤相关缺血性脑卒中急性期，患者神经功能缺损为轻中度，美国国立卫生研究院卒中量表评分为3（1,10）分，大部分患者（56.3%,27/48）以神经系统症状为首发和唯一表现。多因素Logistic回归分析结果显示，肿瘤宽度＜30 mm、肿瘤高活动度、肿瘤表面血栓形成和B型脑钠肽（BNP）水平较低均为心脏黏液瘤相关缺血性脑卒中的独立危险因素(均P<0.05)。结论 心脏黏液瘤临床表现多样。心脏黏液瘤相关缺血性脑卒中患者急性期表现为有轻中度神经功能缺损。较窄的肿瘤宽度、肿瘤高活动度、肿瘤表面血栓形成和较低的BNP水平是心脏黏液瘤相关缺血性脑卒中发生的独立危险因素。

• Objective To investigate the clinical characteristics and risk factors of ischemic stroke associated with cardiac myxoma, and to provide evidence for early identification and diagnosis of ischemic stroke associated with cardiac myxoma. Methods A total of 408 patients with cardiac myxoma admitted to Beijing Anzhen Hospital, Capital Medical University from January 2010 to December 2020 were retrospectively collected. The clinical manifestations of patients with cardiac myxoma and ischemic stroke associated with cardiac myxoma were analyzed, and the risk factors of ischemic stroke associated with cardiac myxoma were analyzed. Results Among 408 patients with cardiac myxoma, 396 patients were included in the analysis, including 48 patients with ischemic stroke associated with cardiac myxoma and 348 patients with cardiac myxoma without ischemic stroke. The clinical symptoms of cardiac myxoma were atypical, mainly characterized by cardiac obstruction, embolism, and constitutional symptoms. In the acute phase of ischemic stroke associated with cardiac myxoma, nerve function defect in patients was mild-to-moderate, with the national institutes of health stroke scale score of 3 (interquartile range: 1-10) and the majority of patients (56.3%, 27/48) in the nervous system symptoms as the first and the only. Multivariate Logistic regression analysis showed that tumor width ＜ 30 mm, tumors with high-mobility, thrombus on the tumor surface, and lower B-type natriuretic peptide levels were independent risk factors for ischemic stroke associated with cardiac myxoma (all P<0.05). Conclusions The clinical manifestations of cardiac myxoma are diverse. Patients with ischemic stroke associated with cardiac myxoma are characterized by mild to moderate neurological deficits in the acute phase. Tumor width＜30 mm, tumors with high-mobility, thrombus on the tumor surface, and lower B-type natriuretic peptide levels are potential risk factors of ischemic stroke associated with cardiac myxoma.