Stroke:关注栓塞性卒中的同时,不应忽视其他脏器栓塞

2018-04-15 杨中华 脑血管病及重症文献导读

隐源性卒中的栓子可能来自于心脏或非狭窄性动脉粥样硬化斑块。这些栓子也可能引起四肢、肠系膜、肾脏和脾脏栓塞。虽然症状性全身梗死很罕见,无症状性内脏梗死常见于近期卒中患者,因此推测卒中和全身性栓塞的栓子是同源的。

隐源性卒中的栓子可能来自于心脏或非狭窄性动脉粥样硬化斑块。这些栓子也可能引起四肢、肠系膜、肾脏和脾脏栓塞。虽然症状性全身梗死很罕见,无症状性内脏梗死常见于近期卒中患者,因此推测卒中和全身性栓塞的栓子是同源的。

2018年3月来自美国的Caitlin Finn等在Stroke上发表了他们的研究结果,目的在于探讨隐源性卒中是否与脏器栓塞有关。

该研究利用了CARSAR(Cornell Acute Stroke Academic Registry,是一项前瞻性登记研究)研究的数据,研究者从中选择了因卒中入院1年内进行过增强腹部CT的患者。

共227例缺血性卒中患者,都进行了增强腹部CT扫描,其中59例发现脏器栓塞(肾脏35个,脾脏27个)。

在心源性卒中、不明原因卒中和大动脉粥样硬化或小血管闭塞性卒中中,内脏梗死的比例存在明显差异,分别为34.2%、23.95和12.5%,P = 0.03。通过调整了人口统计学数据和血管合并症的多元回归模型,研究者发现与非心源性卒中相比,内脏梗死与心源性卒中(odds ratio, 3.5; 95% CI, 1.2–9.9)和隐源性卒中(odds ratio , 3.3; 95% CI, 1.1–10.5)有关。


示例:A图,冠状位和矢状位,肾脏梗死(箭头)



B图,冠状位和矢状位,脾脏梗死(箭头)

最终作者认为不同缺血性卒中亚型的内脏梗死几率存在明显差异。与非心源性卒中相比,心源性和隐源性卒中与内脏栓塞有关。

原始出处:

Finn C,et al.Relationship Between Visceral Infarction and Ischemic Stroke Subtype.Stroke. 2018 Mar;49(3):727-729.

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    2018-04-17 changjiu

    学习一下谢谢

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=306524, encodeId=2807306524b6, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Tue Apr 17 06:15:01 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1536273, encodeId=7c0315362e30d, content=<a href='/topic/show?id=87ec6201043' target=_blank style='color:#2F92EE;'>#栓塞性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62010, encryptionId=87ec6201043, topicName=栓塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6a5012676127, createdName=jiekemin, createdTime=Tue Apr 17 02:22:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026013, encodeId=8f3a1026013e8, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Apr 15 14:22:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306018, encodeId=52d530601834, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Sun Apr 15 12:11:15 CST 2018, time=2018-04-15, status=1, ipAttribution=)]
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    2018-04-15 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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    2018-04-15 changjiu

    学习一下谢谢

    0

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