合并卵圆孔未闭的隐源性脑卒中临床及MRI分析  

Clinical and Imaging Analysis of Cryptogenic Strokewith Patent Foramen Ovale

作　　者：贾林燚[1] 李杰 程芳[3] 庞炳昕 Jia Linyi;Li Jie;Cheng Fang;Pang Bingxin(Department of CT/MR,Xingtai People’s Hospital,Xingtai 054001,China;The Fourth Department of Neurology,Xingtai People’s Hospital,Xingtai 054001,China;Department of Dermatology,Xingtai People's Hospital,Xingtai 054001,China)

机构地区：[1]邢台市人民医院CT/MR科,河北邢台054001 [2]邢台市人民医院神经内四科,河北邢台054001 [3]邢台市人民医院皮肤科,河北邢台054001

出　　处：《南开大学学报（自然科学版）》2023年第6期74-79,共6页Acta Scientiarum Naturalium Universitatis Nankaiensis

基　　金：河北省青年拔尖人才支持项目。

摘　　要：为了探讨合并卵圆孔未闭(PFO)的隐源性脑卒中患者临床及影像学特征,以提高对该病认识及早期影像诊断能力.回顾性分析于我院就诊合并PFO的急性脑梗死患者,分为隐源性卒中(CS)组和非CS组,比较分析两组患者的临床资料及影像学特点.结果表明,共收集37例由经胸超声心动图声学造影(cTTE)和经食道超声心动图(TEE)两项检查确诊的PFO和急性脑梗死患者,根据TOAST分型,不明原因脑梗死(23例,62.2%)为CS组;大动脉粥样硬化型脑梗死(13例,35.1%)和心源性脑梗死(1例,2.7%)为非CS组.CS组患者脑动脉狭窄例数和血同型半胱氨酸(HYC)浓度分别为0例和14.26±8.53 mmol/L,显著低于非CS组(13例,24.39±14.82 mmol/L,P<0.05);反常性栓塞风险量表(RoPE)评分为6.65±1.58分,显著高于非CS组(5.50±1.69分),P<0.05;CS组患者PFO直径、中和大PFO总比例(2.73±1.62 mm,56.5%)明显高于非CS组(1.41±0.87 mm,14.3%),P<0.05;MRI单发梗死灶发生部位依次为皮层下、皮层-皮层下、脑干或小脑(8,1,2例)多于非CS组(4,1,0例),P=1.000;多血管区多发梗死灶比例(43.5%)明显高于非CS组(0.0%),P均<0.05.伴有PFO的隐源性脑卒中患者具有较高的RoPE评分,较大直径的PFO,影像学表现为多血管区多发梗死灶特点,但其临床及影像学特征仍需大样本研究进一步验证.分子动力学模拟结果表明,亚甲基四氢叶酸还原酶433位的E突变为A后对于其结构的稳定性有很大影响,为进一步研究PFO-CS的发病机制提供了新思路.To explore the clinical and imaging features of cryptogenic stroke(CS)patients with patent foramen ovale(PFO)in order to improve the recognition and the ability early imaging diagnosis,37 cases of patients diagnosed as AIS and PFO were retrospectively collected.Patients were divided into cryptogenic stroke(CS)group and non-CS group.The clinical data and imaging characteristics between the two groups were analyzed.Total of 37 patients were investigated including 23 patients(62.2%)with CS and 14 patients(37.8%)with non-CS.The presence of PFO was detected by both contrast transthoracic echocardiography(cTTE)and transesophageal echocardiography(TEE).The ratio of cerebral vascular stenosis and the concentration of homocysteine(HCY)were lower in CS group compared with non-CS group[0 vs 13,(14.26±8.53)mmol/L vs(24.39±14.82)mmol/L,P<0.05].The scores of scale of paradoxical embolism(RoPE),the diameters of PFO and the prevalence of middle and large PFO were higher in CS group than in non-CS group[(6.65±1.58)mm vs(5.50±1.69)mm,(2.73±1.62)mm vs(1.41±0.87)mm,56.5%vs 43.5%,P<0.05].The location of single infarction on MRI was subcortical,subcortical-subcortical,brainstem or cerebellum(8,1,2 cases),more than that in non-CS group(4,1,0 cases),P=1.00;The proportion of multiple infarcts in multi-vessel area(43.5%)was significantly higher than that in non-CS group(0.0%),P<0.05.In conclusion,patients of CS combined with PFO are more likely to have high scores of RoPE,large PFO,and multiple vascular territory lesions.The clinical and imaging features in CS patients with PFO should be identified in further studies.The molecular dynamics simulation results indicate that the E433A mutation of methylenetetrahydrofolate reductase has a significant impact on its structural stability,providing a new approach for further studying the pathogenesis of PFO-CS.

关 键 词：卵圆孔未闭 隐源性卒中 反常性栓塞 

分 类 号：R743[医药卫生—神经病学与精神病学]