Cao Qian, Shen Yu, Hou Zhuo, Li Defu, Tang Boji, Xu Lijun, Li Yanping
Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
Neuropsychiatr Dis Treat. 2022 Jul 26;18:1495-1505. doi: 10.2147/NDT.S367140. eCollection 2022.
Patent foramen ovale (PFO) is potentially associated with abnormal embolisms, and it results in mixing of arteriovenous blood when its right-to-left shunt (RLS) emerges. Present studies have found that PFO is a risk factor that can lead to many diseases. However, few studies have examined the relationship between PFO and dizziness.
This study was a large single-center, prospective, controlled study. From March 2019 to March 2021, we recruited patients with dizziness were divided into two groups: "explained" and "unexplained". All patients were submitted to contrast-enhanced transcranial Doppler ultrasound and screened for PFO. Transesophageal heart ultrasound or right heart catheterization was used to confirm PFO. Additionally, multiple factors were collected and statistical analysis was performed between the two groups.
Among the 244 patients included, 123 were in the "explained" group and 121 were in the "unexplained" group. The prevalence of PFO in the "explained" group was 34 (27.4%) compared to 79 (64.7%) in the "unexplained" group. In the "explained" group, 7 were RLS level IV, 6 were level III, 7 were level II, and 14 were level I. For the "unexplained" group, the numbers of patients with levels IV, III, II and I were 27, 26, 12 and 14, respectively. Univariate analysis revealed that PFO (χ= 34.77, P < 0.001) and age (t = -3.49, P < 0.001) seemed to be potential risk factor candidates for "unexplained" dizziness. In multiple regression analysis, age (OR = 0.97; 95% CI 0.95-0.99) and the prevalence of PFO (OR = 4.37; 95% CI 2.50-7.63) were statistically significant. Massively shunted PFO showed more pronounced risk factors (OR = 8.76; 95% CI 4.04-19.03).
There was a high prevalence of PFO and a greater RLS level in unexplained dizziness. PFO and age were independent risk factors for unexplained dizziness. When treating with unexplained dizziness, especially among young people, we must pay attention to the presence of PFO.
卵圆孔未闭（PFO）可能与异常栓塞有关，当其出现右向左分流（RLS）时会导致动静脉血混合。目前的研究发现，PFO是可导致多种疾病的一个风险因素。然而，很少有研究探讨PFO与头晕之间的关系。
本研究是一项大型单中心、前瞻性对照研究。从2019年3月至2021年3月，我们招募了头晕患者并将其分为两组：“病因明确”组和“病因不明”组。所有患者均接受了对比增强经颅多普勒超声检查并筛查PFO。采用经食管心脏超声或右心导管检查来确诊PFO。此外，收集了多个因素并在两组之间进行了统计分析。
在纳入的244例患者中，“病因明确”组有123例，“病因不明”组有121例。“病因明确”组中PFO的患病率为34例（27.4%），而“病因不明”组为79例（64.7%）。在“病因明确”组中，RLS为IV级的有7例，III级的有6例，II级的有7例，I级的有14例。对于“病因不明”组，IV级、III级、II级和I级的患者人数分别为27例、26例、12例和14例。单因素分析显示，PFO（χ= 34.77，P < 0.001）和年龄（t = -3.49，P < 0.001）似乎是“病因不明”性头晕的潜在风险因素候选。在多因素回归分析中，年龄（OR = 0.97；95% CI 0.95 - 0.99）和PFO的患病率（OR = 4.37；95% CI 2.50 - 7.63）具有统计学意义。大量分流的PFO显示出更明显的风险因素（OR = 8.76；95% CI 4.04 - 19.03）。
在病因不明的头晕中，PFO的患病率较高且RLS水平更高。PFO和年龄是病因不明性头晕的独立风险因素。在治疗病因不明的头晕时，尤其是在年轻人中，我们必须注意PFO的存在。
