反常性栓塞风险量表在合并卵圆孔未闭的隐源性卒中或短暂性脑缺血发作患者中的应用
반상성전새풍험량표재합병란원공미폐적은원성졸중혹단잠성뇌결혈발작환자중적응용
Risk of Paradoxical Embolism Score in Cryptogenic Stroke Patients or Tansient Ischemic Attack with Patent Foramen Ovale
  • 万方数据
    中国卒中杂志 중국졸중잡지
    CHINESE JOURNAL OF STROKE
    2014年 8期 654-662 ,共9页

    郑华光%王伊龙%陈启东%曲辉%胡建科%苑晓春%陆菁菁%鞠奕%宁彬%何文%付强%陈步星%刘丽萍%杨中华%王春雪%董可辉%赵性泉%王拥军%WANG Yong-Jun

    정화광%왕이룡%진계동%곡휘%호건과%원효춘%륙정정%국혁%저빈%하문%부강%진보성%류려평%양중화%왕춘설%동가휘%조성천%왕옹군%WANG Yong-Jun

    卵圆孔未闭%反常性栓塞%右向左分流 卵圓孔未閉%反常性栓塞%右嚮左分流
    란원공미폐%반상성전새%우향좌분류
    Patent foramen ovale%Risk of Paradoxical Embolism score%right-to-left shunt
    目的描述卵圆孔未闭（patent foramen ovale，PFO）造成反常性栓塞（paradoxical embolism，PE）的临床表现、影像学特点。验证反常性栓塞风险量表（Risk of Paradoxical Embolism，RoPE）评分。方法本研究为单中心观察性研究，连续性入选2013年1月～2014年6月首都医科大学附属北京天坛医院神经科收治的隐源性卒中或短暂性脑缺血发作（transient ischemic attack，TIA）患者79例，其中经经颅多普勒超声发泡试验（contrast-enhanced transcranial Doppler，cTCD）和经食管超声心动图（transesophageal echocardiography，TEE）确诊合并PFO的患者44例，其中37例为PFO所致PE，7例仅合并PFO无栓塞症状。由另一名神经科医师盲法评价颅脑磁共振成像，确定其影像学的特点，收集两组患者的人口学信息，临床资料，相关辅助检查（如cTCD、TEE、颈部血管超声及双下肢静脉超声结果），计算并比较两组RoPE评分情况。PFO所致PE患者根据PFO大小分为3组，依据右向左分流量（right-to-left shunt，RLS）大小分为3组。比较不同PFO大小和不同RLS患者之间的临床和影像学特点，并评估不同PFO大小和不同RLS之间的关联性及RoPE评分与PFO的大小和RLS的严重程度之间的关系。结果两组的RoPE评分分别为5（4.5，7.0）和6（4.0，8.0），差异无显著性（P＞0.05）。合并颈内动脉重度狭窄或闭塞，高度提示非PFO相关缺血性卒中（P＜0.01）。小PFO组（＜2 mm）和中/大PFO组（≥2 mm）相比较，两组的RoPE评分分别为（5.5±1.9vs 6.3±2.0，P＞0.05），后者更容易累及后循环。不同RLS患者之间相比较，3组的RoPE评分分别为（5.4±1.7，6.5±2.7，5.8±2.0，P＞0.05）。PFO大小和RLS之间无显著性相关（r=0.031，P＞0.05）。结论 PFO和脑梗死的关系可以分为：无相关性（即PFO合并存在）或有相关性（即PE），PE的影像学特点和PFO大小有一定的相关性。RoPE可能有助于进一步区分PFO的大小和RLS的严重程度。
    목적묘술란원공미폐（patent foramen ovale，PFO）조성반상성전새（paradoxical embolism，PE）적림상표현、영상학특점。험증반상성전새풍험량표（Risk of Paradoxical Embolism，RoPE）평분。방법본연구위단중심관찰성연구，련속성입선2013년1월～2014년6월수도의과대학부속북경천단의원신경과수치적은원성졸중혹단잠성뇌결혈발작（transient ischemic attack，TIA）환자79례，기중경경로다보륵초성발포시험（contrast-enhanced transcranial Doppler，cTCD）화경식관초성심동도（transesophageal echocardiography，TEE）학진합병PFO적환자44례，기중37례위PFO소치PE，7례부합병PFO무전새증상。유령일명신경과의사맹법평개로뇌자공진성상，학정기영상학적특점，수집량조환자적인구학신식，림상자료，상관보조검사（여cTCD、TEE、경부혈관초성급쌍하지정맥초성결과），계산병비교량조RoPE평분정황。PFO소치PE환자근거PFO대소분위3조，의거우향좌분류량（right-to-left shunt，RLS）대소분위3조。비교불동PFO대소화불동RLS환자지간적림상화영상학특점，병평고불동PFO대소화불동RLS지간적관련성급RoPE평분여PFO적대소화RLS적엄중정도지간적관계。결과량조적RoPE평분분별위5（4.5，7.0）화6（4.0，8.0），차이무현저성（P＞0.05）。합병경내동맥중도협착혹폐새，고도제시비PFO상관결혈성졸중（P＜0.01）。소PFO조（＜2 mm）화중/대PFO조（≥2 mm）상비교，량조적RoPE평분분별위（5.5±1.9vs 6.3±2.0，P＞0.05），후자경용역루급후순배。불동RLS환자지간상비교，3조적RoPE평분분별위（5.4±1.7，6.5±2.7，5.8±2.0，P＞0.05）。PFO대소화RLS지간무현저성상관（r=0.031，P＞0.05）。결론 PFO화뇌경사적관계가이분위：무상관성（즉PFO합병존재）혹유상관성（즉PE），PE적영상학특점화PFO대소유일정적상관성。RoPE가능유조우진일보구분PFO적대소화RLS적엄중정도。
    Objective To describe the clinical and image features of paradoxical embolism due to patent foramen ovale (PFO), and to evaluate the Risk of Paradoxical Embolism (RoPE) score. Methods We retrospectively investigated consecutive patients who were suspected to be paradoxical embolism and having PFO admitted to one stroke center in this observational study. PFO was determined by means of TCD salt injection test (contrast-enhanced transcranial Doppler, cTCD) and transesophageal echocardiography (TEE). Demographic data, clinical features, the results of cTCD, TEE and comprehensive compress ultrasound of deep venous in bilateral lower limbs were retrieved with case report form by a neurologist. The patients were divided into 3 groups according to the size of PFO or to the amount of right-to-left shunt. The MRI was evaluated by another neurologist with blinding to the results of cTCD or TEE. PFO was determined to be related to stroke or just by chance after discussing with consultants. The RoPE score and the imaging features were compared within the groups. The relationship between the size of PFO and the amount of RLS was also examined. Results From Jan. 2013 to Jun. 2014, we recruited 79 adult patients with suspected paradoxical embolism. PFO was positive in 44 patients by both cTCD and TEE. After routine consultation, PFO was determined to be causal in the paradoxical embolism in 37 patients and unrelated to stroke in 7 patients. The RoPE scores were 5 (4.5, 7.0) and 6 (4.0, 8.0) respectively and there was no signiifcant difference. Severe stenosis or occlusion in internal carotid artery was more frequent in the group of ischemic stroke with other reasons. The RoPE scores were (5.5±1.9) for PFO <2 mm and (6.3±2.0) for PFO2 mm, there was no signiifcant difference between them. The percentage of post-circulation infarction in PFO <2 mm group was less than that in PFO2 mm (P<0.05) . In the groups by the amount of RLS (1~9 microbubbles, 10~20 microbubbles or >20 microbubbles), the RoPE scores were 5.4±1.7, 6.5±2.7, 5.8±2.0 respectively and were different with no signiifcance. The relationship between the size of PFO and the amount of RLS was tested to be no statistical difference. Conclusion PFO can be causal or unrelated to ischemic stroke. The imaging features might give some clues concerning the size of PFO and the amount of RLS. The RoPE score might provide further information to guide clinical decision.
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