卵圆孔未闭与反常栓塞的相关性及其研究进展

查阅近几年来国内外对"卵圆孔未闭(PFO)与反常栓塞"相关性研究的资料,从定义、诊断、定量诊断及治疗等方面简述了PFO,分析了它导致反常栓塞的相关机制及其相关性。通过PFO伴卒中治疗上的对比研究分析封堵治疗与药物治疗的可行性。     

抗血栓药引发脑出血的治疗进展

缺血性脑卒中、慢性房室颤动和心脏瓣膜术后的患者经常需要长期口服抗血栓凝药物(包括抗血小板、抗凝)治疗,以降低血栓或栓塞性脑血管疾病的发生.然而,抗血栓药物的长期服用容易引发脑出血(intracerebral Hemorrhage,ICH).     

偏头痛与卒中关系研究进展

偏头痛是卒中的独立危险因素,可增加患者尤其女性患者的卒中风险。然而,研究表明偏头痛也可降低卒中的发病风险。偏头痛与卒中的关系尚不明确,大致可分为四种类型:偏头痛性脑梗死,偏头痛与卒中共病因,卒中表现为偏头痛样头痛,卒中与偏头痛共存。     

封堵卵圆孔未闭预防卒中的国外发展及中国现状

经过近20年的争议和大量研究,封堵卵圆孔未闭(patent foramen ovale,PFO)在卒中二级预防中的作用已经明确.本文从循证医学证据入手,回顾近年来国内外经导管封堵PFO预防卒中的研究成果,旨在明确能从封堵治疗中获益的PFO人群.     

封堵治疗与药物治疗卵圆孔未闭隐源性卒中的疗效Meta分析

目的:系统评价卵圆孔封堵治疗与药物治疗隐源性卒中(CS)的疗效与安全性。方法:计算机检索各数据库,纳入关于卵圆孔封堵治疗与药物治疗CS的随机对照研究,进行Meta分析。结果:共纳入10篇文献,包括4 584例患者。与药物治疗相比,PFO封堵治疗后复发性卒中发生率降低(OR 0.47,95%CI 0.33～0.65;异质性P=0.18,I2=29%);两种治疗方案发生TIA风险(OR 1.02,95%CI 0.54～1.94;异质性P=0.03,I2=57%)、出血风险(OR 0.95,95%CI 0.57～1.58;异质性P=0.32,I2=14%)和死亡风险(OR 1.35,95%CI 0.40～4.55;异质性P=0.03,I2=59%)差异均无统计学意义,封堵治疗组新发房颤或房扑的发生率增高(OR 5.73,95%CI 3.08～10.67;异质性P=0.28;I2=20%)。结论:PFO封堵治疗在预防复发性卒中方面优于药物治疗,但封堵治疗可能会增加新发房颤或房扑的发生率。     

卵圆孔未闭与不同年龄人群不明原因脑卒中的相关性研究

目的:探讨卵圆孔未闭(Patent Foramen Ovale,PFO)与不同年龄人群不明原因脑卒中(Cryptogenic Stroke,CS)的相关性。方法:按随机抽样法选取2014年1月~2016年7月我院收治的160例急性脑梗死患者作为观察组,根据年龄分为中青年(<65岁)CS组85例和老年(≥65岁)CS组75例,同时分别选取同年龄段的非脑卒中患者作为相应对照组,所有CS患者均进行发泡试验明确是否存在PFO,探讨两者之间的相关性。结果:观察组老年、中青年CS组的PFO发病率分别为17.3%和23.5%,对照组老年、中青年组的PFO发病率分别为6.7%和和7.1%,差异均有统计学意义,P<0.05;观察组中青年CS组的纤维蛋白原水平与其对照组的相比较,差异有统计学意义,P<0.05;观察组发生PFO与年龄无明显相关性,而PFO是隐源性卒中发作的独立危险因素。结论:PFO与CS具有相关性,但是与年龄并无明显相关性,可进一步深入研究,以给予患者有针对性的有效干预。     

血液标志物在卵圆孔未闭相关隐源性卒中中的表达特点和临床价值

目的 观察血液性标志物在隐源性卒中患者中的表达特点,探讨其临床应用价值.方法 以卵圆孔未闭作为关键词收集患者病历进行回顾性分析,其中依据 TOAST分型标准确诊的隐源性卒中患者 129 例(CS组),缺血性脑卒中患者 75 例(对照组),比较两组患者一般临床资料、凝血指标及炎症相关指标水平.结果 CS组肾小球滤过率、白...     

中青年隐源性DWI阴性急性缺血性脑卒中合并卵圆孔未闭两例

该文报道2例中青年隐源性弥散加权成像(DWI)阴性急性缺血性脑卒中合并卵圆孔未闭男性患者,均为38岁,急性起病,以轻度神经功能缺损症状就诊,既往无脑血管病危险因素,以左侧肢体功能障碍为主要表现,DWI均阴性,经颅多普勒超声发泡检查和经食管心脏彩色多普勒超声检查发现卵圆孔未闭,其后均接受抗血小板、调脂等治疗,好转出院后随访显示2例均接受了卵圆孔未闭封堵治疗,均痊愈。应通过该2例的诊治过程提高对局灶性神经功能缺损合并卵圆孔未闭的认识,当患者出现局灶性神经功能缺损,即使DWI阴性亦不能排除急性缺血性脑卒中,应积极进行危险因素筛查,尤其是在中青年隐源性患者中,应高度重视卵圆孔未闭的检测及治疗,减少卵圆孔未闭所致的脑卒中及卒中复发。     

Valsalva maneuver as migraine inducer: a case report of a woman with patent foramen ovale and an ischemic stroke

The association between patent foramen ovale, ischemic stroke, and migraine with aura is well known. It is, however, complicated and generates a considerable debate about the features and clinical consequences of the phenomenon. We report a case of a woman for whom patent foramen ovale has possibly acted as an inducer of both migraine attacks and ischemic stroke.     

脑卒中合并卵圆孔未闭临床及文献分析

目的:探讨脑卒中合并卵圆孔未闭(PFO)患者的临床特征。方法:回顾性分析2002年1月²012年11月我院收治的及万方数据库和中国医知网报道的脑卒中合并PFO患者41例的临床资料。结果:本组患者年龄<55岁35例(85.4%),有少量吸烟史9例,高血压5例,高血脂1例,糖尿病2例;左侧大隐静脉瓣膜功能不全1例,下肢深静脉血栓6例,髋关节置换术后2例;卵圆孔缺损直径≥2 mm者26例(86.7%);头颅MRI示皮质下白质额叶区、顶叶区梗死各12例。结论:脑卒中合并PFO患者发病年龄偏小,多无常规脑血管病危险因素,卵圆孔缺损直径≥2 mm易发病,确诊需经食管超声心动图、经颅多普勒超声造影等辅助检查。     

Patent foramen ovale and cryptogenic stroke: contemporary evidence and treatment

Introduction: Patent foramen ovale (PFO) is a common anatomical variant in the adult circulation. It is a channel allowing communication between the left and right atria and is a remnant of the foetal circulation. In approximately 25% of the population, this channel persists into adulthood. PFO has been proposed as a potential pathophysiological mechanism for cryptogenic stroke.

Areas covered: This review will examine the contemporary evidence for both the association between cryptogenic stroke and PFO and the management of this condition. The authors hope to provide a comprehensive overview of the current evidence and best practice in relation to PFO closure. In addition, the authors will propose some potential avenues for future research in this controversial area and try to predict how PFOs in cryptogenic stroke will be managed in the near future.

Expert commentary: In carefully selected patients with cryptogenic stroke, PFO closure represents an evidence based treatment option for the prevention of further ischemic neurological events. A multidisciplinary approach is necessary to ensure appropriate patient selection for the procedure. This should include a vascular neurologist/stroke physician and an interventional cardiologist with an interest in PFO closure.     

Prevalence of patent foramen ovale in migraine patients with and without aura compared with stroke patients. A transcranial Doppler study

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7% in migraine with aura (MA) patients, 33.7% in migraine without aura (MoA) patients, 33.8% in young stroke patients and 20.5% in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1% and 25% (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.     

Relationship between migraine and patent foramen ovale: a study of 121 patients with migraine

BACKGROUND: Migraine is a common neurological disorder, the origins of which remain unknown. Patent foramen ovale (PFO) is considered to have a role in migraine. The relationship between migraine and patent foramen ovale may be stronger in patients suffering from migraine with aura compared to patients with common migraine. OBJECTIVES: The aim of the study was to evaluate the frequency of PFO in patients with migraine with aura (MA+) and compare it with the prevalence of PFO in migraine patients without aura (MA-), and in a healthy age-matched control group. We investigated PFO association with migraine, considering such factors as: A type of migraine aura, frequency of attacks, familial occurrence, sex and age of patients. Patients.-121 patients: 61 patients suffering from migraine with aura, 60 without aura and 65 normal controls. The group of patients with migraine with aura was divided into subgroups regarding to the type of aura. METHODS: In order to detect PFO the contrast transcranial Doppler was performed during Valsalva maneuver. RESULTS: The presence of PFO was found in 33/61 (54%) patients with MA(+) compared to 15/60 (25%) without aura and 16/65 (25%) control subjects. The difference between MA(+) patients and MA(-) patients and the difference between MA(+) patients and control group was statistically significant (P < .05). There was no association between type of migraine aura and PFO, as well as we found no association between PFO and frequency of attacks, familial occurrence, sex and age of patients and PFO. CONCLUSIONS: Our findings suggest possible association of migraine with aura and PFO. It seems that PFO does not influence the type of aura and frequency of attacks of migraine as well as it is not associated with familial occurrence of migraine.     

轻型缺血性卒中静脉溶栓后双重抗血小板治疗研究

目的 探讨轻型缺血性卒中重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗后3个月是否能够改善患者的预后,探索轻型缺血性卒中静脉溶栓后24小时,给予双重抗血小板药物治疗是否安全,能否降低患者的卒中复发率并改善预后.方法 传统静脉溶栓组22例,给予rt-PA静脉溶栓,24小时后复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗;联合静脉溶栓组23例,接受rt-PA静脉溶栓后24小时复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗,同时联合氯吡格雷75 mg,每日1次,口服治疗2周,然后继续单用阿司匹林药物治疗;未溶栓组25例,发病时间小于24小时,未接受rt-PA静脉溶栓的轻型卒中患者,常规予阿司匹林100mg,每日1次,口服治疗.3个月时评测美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、改良Rankin量表评分(mRS),其中NIHSS评分0～1分、BI 95～100分、mRS为0～1分者定义为良好结局.评估3个月内脑出血率、病死率和脑梗死复发率.结果 3个月时,传统及联合静脉溶栓组良好结局的比例明显高于未溶栓组(P＜0.05,P＜0.01),传统静脉溶栓组和联合静脉溶栓组之间差异无统计学意义.未溶栓组脑梗死复发率明显高于溶栓组(P＜0.05).3组之间的脑出血率和病死率差异无统计学意义.结论 轻型缺血性卒中rt-PA静脉溶栓治疗可提高3个月内良好结局的比例、减少卒中的复发.轻型缺血性卒中rt-PA静脉溶栓后24小时,短期给予双重抗血小板治疗,不增加脑出血风险.     

C-TCD与TEE在筛选卵圆孔未闭相关性隐源性卒中中的诊断价值

目的探究经颅多普勒发泡实验(C-TCD)和经食道超声心动图(TEE)在筛查卵圆孔未闭(PFO)相关性隐源性卒中(CS)中的诊断价值。方法收集2018年10月至2019年9月于我院神经内科收治的CS患者105例,均行C-TCD与TEE检查。分析两种方式对PFO的检出情况。结果105例CS患者中,经C-TCD平静呼吸时PFO检出率为35%(阳性37例,阴性68例);经TEE的PFO检出率为42%(阳性44例,阴性61例)。两种方法对PFO的检出率比较,差异无统计学意义(P>0.05)。C-TCD行Valsalva动作后的PFO检出率为56%(阳性59例,阴性46例),与TEE的检出率比较,差异具有统计学意义(P<0.05)。结论C-TCD与TEE对PFO均有较高的检出率,Valsalva动作可提高检出率,C-TCD可作为临床工作中筛选PFO的首选方法。