Li X Q, Yuan P, Ma W J, Liu G Z
Department of Neurology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2018 May 22;98(19):1507-1510. doi: 10.3760/cma.j.issn.0376-2491.2018.19.011.
To investigate the pathogenesis of young and middle-aged stroke patients with patent foramen ovale (PFO) by analyzing clinical characteristics. Data of 298 consecutive young and middle-aged patients diagnosed as stroke were retrospectively collected from Department of Neurology, Beijing Anzhen Hospital from January 2010 to January 2017.Patients were divided into cryptogenic stroke (CS) group and not-CS group.Risk factors, characteristics of PFO and infarct of imaging were analyzed between two groups. PFO was confirmed in 88 patients among 298 young and middle-aged stroke patients.The prevalence of PFO was 29.6%. Forty-six patients were assigned into CS group and 42 patients were assigned into not-CS group.The ratio of atrial fibrillation and internal carotid artery stenosis in CS group was lower than that in not-CS group (0 vs 12, 4 vs 22, <0.05). The concentration of homocysteine was lower in CS group than that in not-CS group [(10.4±1.1) mmol/L vs(14.6±2.4) mmol/L, <0.05]. The difference of migraine and scores of scale of Risk of Paradoxical Embolism (RoPE) in CS group were significantly higher than those in not-CS group [18 vs 4, (6.8±2.5)vs (5.5±1.4), <0.05]. The prevalence of big PFO, constant right-to-left shunt and atrial septal aneurysm (ASA) in CS group was higher than that in not-CS group (26 vs 6, 36 vs 18, 5 vs 0, <0.05). Post-circulation location, single cortex infarction and multiple infarctions in multiple vascular areas are indicative of PFO (25 vs 18, 15 vs 7, 20 vs 8, <0.05). Migraine, high scores of RoPE, big PFO, constant RLS and ASA are indicative of important role of PFO in cryptogenic stroke in young and middle-aged patients.The imaging characteristics of CS with PFO should be emphasized.
通过分析临床特征探讨中青年卵圆孔未闭（PFO）型卒中患者的发病机制。回顾性收集2010年1月至2017年1月北京安贞医院神经内科连续收治的298例中青年卒中患者的资料。将患者分为隐源性卒中（CS）组和非CS组。分析两组之间的危险因素、PFO特征及影像学梗死情况。298例中青年卒中患者中88例确诊为PFO，PFO患病率为29.6%。46例患者被分配到CS组，42例患者被分配到非CS组。CS组房颤和颈内动脉狭窄的比例低于非CS组（0比12，4比22，<0.05）。CS组同型半胱氨酸浓度低于非CS组[（10.4±1.1）mmol/L比（14.6±2.4）mmol/L，<0.05]。CS组偏头痛及反常栓塞风险（RoPE）量表评分差异显著高于非CS组[18比4，（6.8±2.5）比（5.5±1.4），<0.05]。CS组大PFO、持续性右向左分流及房间隔瘤（ASA）的患病率高于非CS组（26比6，36比18，5比0，<0.05）。后循环部位、单皮质梗死及多血管区域的多发梗死提示PFO（25比18，15比7，20比8，<0.05）。偏头痛、RoPE高分、大PFO、持续性右向左分流及ASA提示PFO在中青年隐源性卒中中起重要作用。应重视PFO型CS的影像学特征。
