Analysis Of Relative Risk Factors For Ischemic Cerebral Small Vessel Disease With Right-to-left Shunt

Objective: By collecting information of patients with right-to-left shunt,analysis the risk factors for ischemic cerebral small vessel disease with right-to-left shunt patients,analysis the correlation between different degrees of right-to-left shunt and ischemic cerebrovascular disease,and provide guidance for the intervention and treatment of ischemic cerebral small vessel disease with right-to-left shunt patients.Methods: This study selected patients with neurological symptom who were hospitalized in the department of Neurology in Zhongshan Hospital of Dalian University,from August 2017 to November 2019.They were screened by cranial CT to exclude serious intracranial diseases and the contrast transcranial doppler confirmed the right-to-left shunt of them.Right-to-left shunt are divided into small shunts(micro-emboli signals are less than 10),moderate shunts(micro-emboli signals are 10-25)and large shunts(micro-emboli signals are much than 25 or rain curtains)according to severity.All patients completed the cranial MRI imaging examinations(including T1 WI,T2WI,Flair and DWI).Professional imaging physicians and neurologists judged whether there is ischemic cerebral small vessel disease.It refers to lacunar infarction(including acute and / or obsolete)and white matter hyperintensities.The basic clinical information and laboratory information of the patients were collected at the same time.Patients with ischemic cerebral small vessel disease confirmed by cranial MRI were included in the positive group,and patients without ischemic cerebral small vessel disease were included in the negative group.A case-control study was used to compare the clinical data and laboratory data between the two groups,using the Logistic regression analysis analyze the independent risk factors.Subgroup analyzing right-to-left shunt patients without hypertension and diabetes.Analyzing the correlation between different degrees of right-to-left shunt flow and ischemic cerebral small vessel disease.Results: A total of 600 patients with right-to-left shunt were enrolled,including 405 patients with ischemic cerebral small vessel disease confirmed by cranial MRI in the positive group and 195 patients without ischemic cerebrovascular disease in the negative group.All patients admitted to the hospital with neurological symptoms as the main complaint.Contrast transcranial doppler results show there was no significant difference in the incidence of each shunt between the positive group and the negative group(P= 0.244).Univariate analysis shows that the average age,the proportion of males,the prevalence of hypertension and diabetes of patients in the positive group were significantly higher than those in the negative group(P<0.05).The platelet and high density lipoprotein of patients in the positive group were lower than those in the negative group,and the difference was statistically significant(P<0.05).The homocysteine in the positive group was significantly higher than that in the negative group(P<0.05).By multivariate logistic regression analysis,age(OR=1.100,95%CI= 1.073-1.128,P<0.05)and hypertension(OR=1.690,95%CI=1.060-2.693,P<0.05)were the independent risk factors for ischemic cerebral small vessel disease.Subgroup analysis,a total of 269 patients without hypertension and diabetes were enrolled,including 104 cases of small shunts,42 cases of moderate shunts,and 123 cases of large shunts.There was no significant difference in gender,age,and laboratory test data among the groups(P>0.05).Among the three groups,there was no significant difference in the incidence of lacunar infarction(P=0.195)and there was no significant difference in the grade of white matter hyperintensities(P=0.593).Further comparing every two groups,there was no significant difference in the incidence of lacunar infarction and the grade of white matter hyperintensities(P>0.05).Conclusion:1.In right-to-left shunt patients,age and hypertension are the independent risk factors for ischemic cerebral small vessel disease.2.In right-to-left shunt patients,diabetes,abnormal lipid metabolism,and hyperhomocysteinemia may also increase the incidence of ischemic cerebral small vessel disease.3.The severity of right-to-left shunt may not be related to ischemic cerebral small vessel disease in patients without hypertension and diabetes.