Department of Cardiology, Guang'an People's Hospital, Guang'an City, Sichuan Province, China.
Eur Rev Med Pharmacol Sci. 2024 Feb;28(3):1027-1035. doi: 10.26355/eurrev_202402_35338.
The purpose of this study was to evaluate the relationship between the right-to-left shunt of the patent foramen ovale and the risk score for paradoxical embolism in cryptogenic stroke, as well as the risk factors for the development of cryptogenic stroke.
A retrospective analysis was performed on 257 patients with cryptogenic stroke who were diagnosed and treated in our hospital from February 2020 to January 2022 as a study group, and 98 patients who were diagnosed and treated at the Department of Neurology in our hospital at the same time and excluded from stroke, were selected as the control group. Transcranial Doppler ultrasound acoustic contrast testing was used to grade right-to-left shunts of patent foramen ovale. Clinical information of individuals who had cryptogenic strokes was examined. The correlation between the right-to-left shunt of patent foramen ovale and the risk score for both cryptogenic stroke and paradoxical embolism was analyzed. The factors affecting the occurrence of cryptogenic stroke were investigated. The correlation between right-to-left shunt and paradoxical embolism risk score was explored. Receiver operator characteristic curve (ROC) analysis was used to evaluate each factor's clinical usefulness in predicting the occurrence of cryptogenic stroke.
No difference was observed in the history of hypertension, low-density lipoprotein, C-reactive protein and fibrinogen between the control group and the study group (p<0.05). In the study group with patent foramen ovale, the proportion of patients with grades I and II of the right-to-left shunt of patent foramen ovale was significantly lower than that in the control group, while the percentage of patients with grades III and IV was obviously greater than that in the control group (p<0.05). Right-to-left shunt grade, C-reactive protein, and fibrinogen were independent risk factors for cryptogenic stroke by logistic multivariate regression analysis (p<0.05). With an increase in the right-to-left shunt of the patent foramen ovale, patients' risk scores for paradoxical embolism increased considerably (p<0.05). In patients with cryptogenic stroke, the right-to-left shunt grade of the patent foramen ovale was positively connected with the paradoxical embolism risk score (r=0.331, p<0.001). ROC analysis results showed that the areas under the curves (AUC) of right-to-left shunt grading, C-reactive protein, and fibrinogen were 0.651, 0.871, and 0.779, respectively. The combination of the three indexes had an AUC of 0.908, a sensitivity of 87.90%, a specificity of 82.70%, and a Youden index of 0.706, indicating a high predictive value of the combination.
The right-to-left shunt of patent foramen ovale was an independent risk factor for cryptogenic stroke, which was positively correlated with the paradoxical embolic risk score. Its combination with clinical serologic indexes had a high clinical value for predicting cryptogenic stroke.
本研究旨在评估卵圆孔未闭右向左分流与隐源性卒中的矛盾栓塞风险评分之间的关系，以及隐源性卒中的发病危险因素。
选取 2020 年 2 月至 2022 年 1 月在我院诊断和治疗的 257 例隐源性卒中患者作为研究组，采用经颅多普勒超声声学造影检查对卵圆孔未闭的右向左分流进行分级。同时选取我院神经内科同期诊断但排除卒中的 98 例患者作为对照组。回顾性分析隐源性卒中患者的临床资料，分析卵圆孔未闭右向左分流与隐源性卒中及矛盾栓塞风险评分的相关性，探讨影响隐源性卒中发生的因素。探索右向左分流与矛盾栓塞风险评分的相关性。采用受试者工作特征曲线（ROC）分析各因素预测隐源性卒中发生的临床价值。
对照组与研究组在高血压病史、低密度脂蛋白、C 反应蛋白、纤维蛋白原方面无差异（p<0.05）。卵圆孔未闭组患者的右向左分流程度 I 级和 II 级比例明显低于对照组，III 级和 IV 级比例明显高于对照组（p<0.05）。多因素 logistic 回归分析显示，右向左分流程度、C 反应蛋白、纤维蛋白原是隐源性卒中的独立危险因素（p<0.05）。随着卵圆孔未闭右向左分流程度的增加，患者的矛盾栓塞风险评分显著升高（p<0.05）。在隐源性卒中患者中，卵圆孔未闭的右向左分流程度与矛盾栓塞风险评分呈正相关（r=0.331，p<0.001）。ROC 分析结果显示，右向左分流程度分级、C 反应蛋白、纤维蛋白原的曲线下面积（AUC）分别为 0.651、0.871、0.779，三者联合的 AUC 为 0.908，灵敏度为 87.90%，特异性为 82.70%，约登指数为 0.706，提示联合指标具有较高的预测价值。
卵圆孔未闭的右向左分流是隐源性卒中的独立危险因素，与矛盾栓塞风险评分呈正相关。其与临床血清学指标联合应用对预测隐源性卒中具有较高的临床价值。
