应用卵圆孔未闭相关卒中因果可能性分类系统评价卵圆孔未闭相关缺血性脑血管病的初步分析  

Preliminary study on the application of patent foramen ovale associated stroke causal likelihood classification system in evaluating ischemic cerebral vascular diseases associated with patent foramen ovale

作　　者：董静[1] 郄静媛 马欣[1] Dong Jing;Qie Jingyuan;Ma Xin(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国脑血管病杂志》2023年第10期659-666,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的初步探索卵圆孔未闭(PFO)相关卒中因果可能性(PASCAL)分类系统在PFO相关隐源性缺血性脑血管病(ICVD)中的应用价值。方法回顾性连续纳入2012年5月1日至2021年12月31日于首都医科大学宣武医院神经内科住院的隐源性ICVD患者107例,均行经食道超声心动图或经颅多普勒超声等渗盐水发泡试验明确存在PFO相关右向左分流。记录患者人口学资料(年龄、性别)、脑血管病相关危险因素[高血压病、糖尿病、高脂血症、卒中史、短暂性脑缺血发作(TIA)史、吸烟、饮酒、脑血管病家族史]、心脏病史(冠心病、心力衰竭、心脏瓣膜病、扩张型心肌病、先天性心脏病等)、皮质梗死、脑血管病相关实验室指标(血红蛋白、白细胞计数、血小板计数、总胆固醇、三酰甘油、低密度脂蛋白、同型半胱氨酸、D-二聚体、纤维蛋白原)水平。PASCAL分类系统对PFO相关ICVD的判定如下:(1)PFO很可能与ICVD相关为反常性栓塞风险(RoPE)评分≥7分且具备至少一种PFO解剖危险特征;(2)PFO可能与ICVD相关为RoPE评分≥7分或具备至少一种PFO解剖危险特征;(3)PFO与ICVD无关为RoPE评分<7分且缺乏任一种PFO解剖危险特征,其中的PFO解剖危险特征包括大量右向左分流、并发房间隔膨胀瘤。将107例隐源性ICVD患者分为PASCAL很可能组(PFO很可能与ICVD相关)、PASCAL可能组(PFO可能与ICVD相关)、PASCAL无关组(PFO与ICVD无关),PASCAL很可能组与PASCAL可能组统称为PASCAL相关组。分别对PASCAL相关组与PASCAL无关组、PASCAL很可能组与PASCAL可能组各项指标进行比较。以PASCAL很可能相关为因变量,将PASCAL很可能组与PASCAL可能组单因素分析中组间差异有统计学意义(P<0.05)的项目作为自变量进一步行多因素Logistic回归分析。结果(1)107例隐源性ICVD患者中,PASCAL相关组患者93例(PASCAL很可能组32例、PASCAL可能组61例),PASCAL无关组患者14例。PASCAL相关组伴有PFObjective Preliminarily exploration the application value of the patent foramen ovale(PFO)associated stroke causal likelihood(PASCAL)classification system in PFO related cryptogenic ischemic cerebral vascular disease(ICVD).Methods A total of 107 hospitalized patients with cryptogenic ICVD and PFO related right-to-left shunt were retrospectively and consecutively recruited in the Department of Neurology of Xuanwu Hospital,Capital Medical University from May 1st,2012 to December 31st,2021.The PFO related right-to-left shunt was confirmed by transesophageal echocardiography or transcranial Doppler bubble test.Baseline data were collected in terms of demographic information(age,gender),ICVD risk factors(hypertension,diabetes mellitus,hyperlipidemia,stroke,transient ischemic attack,smoking,alcohol consumption,family history of stroke),cardiac diseases(coronary cardiac disease,heart failure,valvular heart disease,dilated cardiomyopathy,congenital heart disease),cortical infarction,ICVD related blood tests(hemoglobin,white blood cell count,platelet count,total cholesterol,triglyceride,low density lipoprotein,homocysteine,D dimer,fibrinogen).The PASCAL criteria for determining PFO related ICVD were listed as follows:(1)ICVD with risk of paradoxical embolism(RoPE)score≥7 and with at least one anatomical risk characteristics of PFO were classified as probable PFO related ICVD;(2)ICVD with RoPE score≥7 or with at least one anatomical risk characteristics of PFO feature were classified as possible PFO related ICVD;(3)ICVD with RoPE score<7 and without any anatomical risk characteristics of PFO features were classified as unlikely PFO related ICVD.The anatomical risk characteristics of PFO features consisted of large amount right-to-left shunt and atrial septal aneurysm.Based on the PASCAL classification system,107 patients with cryptogenic ICVD were classified into PASCAL probably related group(PFO was probably related to ICVD),PASCAL possibly related group(PFO was possibly related to ICVD)and PASCAL unlikely related gro

关 键 词：卵圆孔 未闭 隐源性缺血性脑血管病 分类 评价 

分 类 号：R743.3[医药卫生—神经病学与精神病学]