中青年卵圆孔未闭持续性右向左分流与隐源性脑卒中的相关性分析  

Correlation Analysis Between Persistent Right-to-left Shunt of Patent Foramen Ovale and Cryptogenic Stroke in Young and Middle-aged Adults

作　　者：徐亮[1] 周畅[1] 李洁[1] 韩仲谋 周军[1] XU Liang;ZHOU Chang;LI Jie;HAN Zhongmou;ZHOU Jun(Department of Ultrasound,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges UniversityYichang 443003,Hubei,China)

机构地区：[1]三峡大学第一临床医学院(宜昌市中心人民医院)超声科

出　　处：《中国循环杂志》2020年第2期171-174,共4页Chinese Circulation Journal

摘　　要：目的:采用经胸超声心动图声学造影(cTTE)联合经食道超声心动图(TEE)方法探讨中青年卵圆孔未闭右向左分流的类型与隐源性脑卒中的相关性。方法:收集我院门诊及住院的隐源性脑卒中患者118例(脑卒中组)及同期来我院健康体检的志愿者112例(对照组),两组均进行cTTE及TEE检查,观察卵圆孔未闭发生情况,同时根据cTTE检查左心腔内出现的微泡数半定量的将右向左分流划分3个等级:1~10个微泡/帧为少量分流;11~30个微泡/帧为中量分流;>30个微泡/帧为大量分流。比较两组中卵圆孔未闭患者持续性右向左分流(在静息状态下即出现的右向左分流)与一过性右向左分流(静息状态下无右向左分流,仅在Valsalva动作后出现右向左分流)发生情况及两组右向左分流量情况。结果:脑卒中组患者中合并卵圆孔未闭的比例(41.53%vs 26.78%,P<0.05)、卵圆孔未闭患者中持续性右向左分流的比例(20.34%vs 8.03%,P<0.01)均明显高于对照组。静息状态下持续性少量和中量右向左分流:在脑卒中组中分别是13例(11.02%)、5例(4.24%),对照组中分别是8例(7.14%)、1例(0.89%),两者比较差异均无统计学意义(P>0.05);静息状态下持续性大量右向左分流:脑卒中组6例(5.08%),对照组0例(0%),两者比较差异有统计学意义(P<0.05)。两组在一过性右向左分流的不同程度分流量方面差异均无统计学意义(P均>0.05)。结论:隐源性脑卒中与卵圆孔未闭持续性右向左分流密切相关。静息状态下存在持续性大量右向左分流可能是隐源性脑卒中的重要原因。Objectives:To explore the relationship between right to left shunt(RLS)type of patent foramen ovale(PFO)and cryptogenic stroke in young and middle-aged adults by contrast transthoracic echocardiography(cTTE)combined with transesophageal echocardiography(TEE).Methods:Totally 118 patients with crgptogenic stroke(stroke group)from either the outpatient or inpatient and 112 cases of normal healthy volunteers(control group)were enrolled.cTTE and TEE were performed in both groups to observe the occurrence of PFO,and according to the number of microbubbles in the left heart examined by cTTE,RLS was semi-quantitatively divided into 3 grades:1 to 10 microbubbles/frame were classed as small shunt;11 to 30 microbubbles/frame were classed as moderate shunt;>30 microbubbles/frame were classed as large shunt.The persistent RLS(RLS occurs in the resting state)and transient RLS(no RLS in resting state,RLS occurs only after the Valsalva maneuver)in the two groups were compared,and the right to left shunt amount of PFO patients in the two groups was compared.Results:The incidence of PFO in stroke group was higher than that in control group(41.53%vs 26.78%,P<0.05).The incidence of persistent RLS among PFO patients in the stroke group was significantly higher than that in the control group(20.34%vs 8.03%,P<0.01).Number of patients with the large amount of RLS in the resting state of the stroke group was higher than that in the control group(5.08%vs 0%,P<0.05),while there was no statistically significant difference in individuals with the small and moderate amount of RLS between the stroke and control group(11.02%vs 7.14%,4.24%vs 0.89%,respectively,all P>0.05).There was also no statistically significant difference in the amount of transient RLS between the two groups(all P>0.05).Conclusions:Crgptogenic stroke is closely related to the persistence of RLS of patent foramen ovale.The existence of a large persistent RLS in resting state is an important cause of cryptogenic stroke.

关 键 词：隐源性脑卒中 卵圆孔未闭 右向左分流 经胸超声心动图声学造影 经食道超声心动图 

分 类 号：R541[医药卫生—心血管疾病]