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- 2018
隐源性脑梗死患者反常性栓塞量表评分与右向左分流严重程度的关系
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Abstract:
摘要：目的 描述合并与不合并右向左分流(right-to-left shunt, RLS)的隐源性脑梗死(cryptogenic stroke, CS)患者的临床特点。评估CS患者RLS严重程度与反常性栓塞量表(risk of paradoxical embolism, RoPE)评分的关系。方法 回顾性分析西安交通大学第二附属医院神经内科2014.1-2016.11合并RLS与不合并RLS的138例CS患者的临床特征，评估经颅多普勒发泡试验(control-enhanced transcranial doppler, c-TCD)发现的RLS严重程度与RoPE评分的相关关系。记录c-TCD和对比增强经胸超声心动图(contrast-enhanced transthoracic echocardiography, c-TTE)两种检查方法静息下、Valsalva动作下RLS分级情况，分别比较两种检查方法静息下与Valsalva动作下RLS的发现率，并比较两种方法对RLS分级诊断的一致性。结果 RoPE评分与RLS严重程度呈正相关(rank correlation, r=0.26，P<0.05)。合并与不合并RLS的两组CS患者中，临床特征有所不同。Valsalva动作可提高c-TCD及c-TTE对RLS的发现率(P<0.01)；两种检查方法在诊断RLS分级方面具有中等程度的一致性(Kappa=0.428)。结论 在合并RLS的CS患者中，RoPE评分与c-TCD评价的RLS的严重程度呈正相关。Valsalva动作可提高c-TCD、c-TTE两种检查方法发现RLS的阳性率。
ABSTRACT: Objective To compare the clinical features between cryptogenic stoke (CS) with and without right-to-left shunt (RLS) so as to determine whether shunt severity determined by control-enhanced transcranial Doppler (c-TCD) is correlated with the risk of paradoxical embolism (RoPE) score. Methods We made a retrospective analysis of clinical characteristics of 138 CS patients with and without RLS admitted to our department between January 2014 and November 2016. For patients documented by c-TCD, we evaluated whether there was a correlation between RLS severity and RoPE score. RLS was diagnosed by c-TCD and contrast-enhanced transthoracic echocardiography (c-TTE). We compared every modality for detecting RLS with and without Valsalva maneuver. For patients found with RLS in c-TCD and c-TTE, we judged whether there was an agreement in grading RLS between two modalities. Results For patients with CS, shunt severity by c-TCD was positively correlated with RoPE score (r=0.26, P=0.05). The clinical features were different between CS patients with RLS and without RLS. Compared with the positive results of c-TCD and c-TTE at rest, the positive rate was higher in Valsalva maneuver, respectively (P<0.01). There was a moderate agreement between shunt grades identified by the two techniques (Kappa=0.428). Conclusion There is a positive correlation between RoPE score and RLS severity determined by c-TCD in CS patients. Valsalva maneuver can significantly increase the positive rate of RLS detected by c-TCD and c-TTE
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