唐舒锦范玉华陈红兵尚文锦李晶晶曾进胜

伴右向左分流的隐源性缺血性卒中的临床和影像学特征☆

唐舒锦*范玉华*陈红兵*尚文锦*李晶晶*曾进胜*

目的分析右向左分流相关隐源性缺血性卒中患者的临床特点及梗死灶影像特征。方法纳入隐源性缺血性卒中患者52例，根据经颅多普勒发泡试验结果分为伴右向左分流组（25例）及不伴右向左分流组（27例）。比较两组人群在人口学资料、脑血管病传统危险因素、梗死灶影像学等方面的差异。结果两组患者的年龄、性别比差异无统计学意义。伴右向左分流组患者无明确脑血管病传统危险因素的比例明显高于不伴右向左分流组（44%vs.14.8%，P=0.015），且其发生后循环梗死也更多见（56%vs.14.8%，P＜0.01），但两组患者的梗死灶大小无统计学差异（P＞0.05）。结论无明确脑血管病传统危险因素的后循环梗死患者，应注意排查是否存在右向左分流，以进一步明确卒中病因。

隐源性卒中右向左分流反常栓塞影像特征危险因素

【Abstract】Objective To investigate the clinical and imaging characteristics in cryptogenic stroke with right-to-left shunt（RLS）.Methods Fifty-two patients with cryptogenic ischaemic stroke were included in the study and divided into two groups according to transcranial Doppler（TCD）bubble test：RLS group（twenty-five patients）and non-RLS group（twenty-seven patients）.The demographic data，traditional risk factors of stroke and characteristics of le⁃sion patterns were compared between two subgroups.Results There was no significant difference between the groups in age or sex ratio.The percentage of patients with no risk factors was significantly higher in RLS group than non-RLS group（44%vs.14.8%，P=0.015）.The lesion was more frequently observed in the vertebrobasilar artery territory in RLS group（56%vs.14.8%，P＜0.01）.However，there was no other significant difference in lesion patterns，such as infarct size，single/multiple lesions，superficially/deeply located between these two groups（P＞0.05）.Conclusions Vertebrobasilar Stroke without traditional cerebrovascular risk factors is more likely to be RLS-associated，which requires an advanced TCD bubble test to find the potential cause of stroke.

【Key words】Cryptogenic stroke Right-to-left shunt Paradoxical embolism Imaging characteristics Risk factors

☆2014年广东省公益研究与能力建设专项资金（编号：2014B-020212003）；“广东省重大神经疾病诊治研究重点实验室”和“卫计委国家临床重点专科”专项基金资助

*中山大学附属第一医院神经科，广东省重大神经疾病诊治研究重点实验室（广州510080）

隐源性缺血性卒中（cryptogenic ischaemic stroke，CIS）是指经当前临床常规检查评估仍病因不明的缺血性卒中，目前其定义尚未完全确定。CIS约占所有缺血性卒中的1/4～1/3，多见于青-中年患者［1-2］。近年来，随着诊断评估技术的进步，这些患者的隐匿卒中病因逐渐被认识，主要包括：卵圆孔未闭（patent foramen ovale，PFO）、阵发性房颤、主动脉弓/降主动脉斑块脱落等［1-2］。……