肺动脉高压是伴右至左分流的隐源性脑卒中患者的危险因素

Pulmonary Hypertension as a Risk Factor in Cryptogenic Stroke Patients with Right-to-Left Shunt

摘要: 目的：本研究旨在探讨CS患者RLS与PH之间的关联，并进一步探究PH对CS患者卒中发生的潜在贡献。方法：PH通过右心导管检查确诊，并经胸超声心动图采集心脏参数，通过发泡实验明确RLS的存在及分流程度。此外，采用logistic回归分析脑血管病危险因素和心脏参数指征。结果：本研究共纳入383例患者。PH在CS患者中的患病率明显高于无CS患者(P < 0.001)。此外，CS在PH组中的发病率高于无PH组(P < 0.001)。PH的发生率RLS 组高于RLS−组(P = 0.042)，且在大分流组高于小分流组(P < 0.001)。PH组比无PH组更常观察到大分流的发生(P < 0.001)。经过多因素分析，PH是CS患者卒中发生的危险因素(OR: 4.151, 95% CI: 1.317~13.086, P = 0.015)。结论：与无CS患者相比，CS患者合并PH，且PH的发生可能与RLS相关，并受分流程度的影响。此外，PH可能是CS患者卒中发生的危险因素，且可能成为预测RLS患者缺血性卒中发生的重要因素。

Abstract: Aim: The aim of this study was to investigate the association between RLS and PH in CS patients, and to further explore the potential contribution of PH to stroke occurrence in CS patients. Method: PH was confirmed by right cardiac catheterization, cardiac parameters were collected by transthoracic echocardiography, and the presence and degree of RLS were determined by foaming test. In addition, logistic regression was used to analyze the risk factors of cerebrovascular disease and the indications of cardiac parameters. Results: A total of 383 patients were included in this study. PH exhibited a significantly higher prevalence in patients with CS than those without CS (P < 0.001). Moreover, CS manifested significantly more frequently in the PH group than in the non-PH group (P < 0.001). The incidence of PH in RLS group was higher than that in RLS− group (P = 0.042), and the incidence of PH in large shunt group was higher than that in small shunt group (P < 0.001). A large shunt was observed more commonly in the PH group than in the no-pH group (P < 0.001). After multivariate analysis, PH was a risk factor for stroke in CS patients (OR: 4.151, 95% CI: 1.317~13.086, P = 0.015). Conclusions: Compared with patients without CS, patients with CS have combined PH, and the occurrence of PH may be related to RLS and influenced by the degree of shunt. In addition, PH may be a risk factor for stroke in patients with CS and may be an important predictor of ischemic stroke in patients with RLS.