CAJ | 학술논문

流行病学研究显示,原因不明性卒中患者中的卵圆孔未闭(patent foramen ovale,PFO)患病率显著高于普通人群,二者之间的密切联系支持反常性栓塞为卒中病因的假说.然而,在原因不明性卒中患者中,单纯检测到PFO并不能确立反常性栓塞的诊断.当PFO与其他一些因素共存时,会显著增高缺血性卒中风险.一些研究显示,伴有PFO的原因不明性卒中患者的MRI病灶模式与无PFO者并无显著差异,特别是多发性缺血灶,因此不支持反常性栓塞作为PFO患者卒中病因的理论.PFO的检测方法包括经胸壁超声心动图、经食管超声心动图(transesophageal echocardiography,TEE)和经颅多普勒(transcranial Doppler,TCD).TCD与TEE具有良好的一致性,因此应被推荐为一种简单、无创和可靠的技术,而TEE仅应在经过选择的患者中进行.PFO的治疗选择包括抗血小板药、抗凝药、经皮血管内封堵术和开胸手术.在几项重要的大样本随机对照试验完成之前,对于伴有PFO的原因不明性卒中患者,经皮封堵术仅应考虑用于治疗在接受内科治疗过程中仍然出现复发性事件、对内科治疗存在禁忌证以及某些高危解剖学风险的PFO.
류행병학연구현시,원인불명성졸중환자중적란원공미폐(patent foramen ovale,PFO)환병솔현저고우보통인군,이자지간적밀절련계지지반상성전새위졸중병인적가설.연이,재원인불명성졸중환자중,단순검측도PFO병불능학립반상성전새적진단.당PFO여기타일사인소공존시,회현저증고결혈성졸중풍험.일사연구현시,반유PFO적원인불명성졸중환자적MRI병조모식여무PFO자병무현저차이,특별시다발성결혈조,인차불지지반상성전새작위PFO환자졸중병인적이론.PFO적검측방법포괄경흉벽초성심동도、경식관초성심동도(transesophageal echocardiography,TEE)화경로다보륵(transcranial Doppler,TCD).TCD여TEE구유량호적일치성,인차응피추천위일충간단、무창화가고적기술,이TEE부응재경과선택적환자중진행.PFO적치료선택포괄항혈소판약、항응약、경피혈관내봉도술화개흉수술.재궤항중요적대양본수궤대조시험완성지전,대우반유PFO적원인불명성졸중환자,경피봉도술부응고필용우치료재접수내과치료과정중잉연출현복발성사건、대내과치료존재금기증이급모사고위해부학풍험적PFO.
Epidemiological studies have shown that the incidence of patent foramen ovale (PFO) in patients with cryptogenic stroke is significantly higher than general population.The close association between cryptogenic stroke and PFO supports the hypothesis that paradoxical embolism is a cause of stroke.However,the detection of PFO alone does not establish the diagnosis of paradoxical embolism in patients with cryptogenic stroke. The risk of ischemic stroke will increase significantly when PFO and other factors coexist.Some studies tave shown that there is significant difference between the MRI lesion patterns in patients with cryptogenic stroke and PFO in those without cryptogenic stroke,particularly in multiple ischemic lesions.Therefore,it does not support the theory of paradoxical embolism as a cause of stroke in patients with PFO.The PFO detection methods include transthoracic echocardiography,transesophageal echocardiography (TEE) and transcranial Doppler (TCD).TCD and TEE have a good consistency.Accordingly,TCD should be recommended as a simple,noninvasive,and reliable technique,while TEE should be only restricted to the selected patients.The treatment options of PFO include antiplatelet drugs,anticoagulant drugs,percutaneous vascular closure,and thoracotomy.Percutaneous vascular closure should only be considered the recurrent events during the medical treatment,the contraindications of medical treatment,and PFO with some anatomical high risks for patients with cryptogenic stroke with PFO before the completion of several large randomized controlled trials.