卵圆孔未闭合并隐源性卒中介入封堵与药物的疗效对比

康雪; 李海洋; 孙阳阳; 侯莉微; 陈桂生

doi:10.16016/j.1000-5404.202105100

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卵圆孔未闭合并隐源性卒中介入封堵与药物的疗效对比

临床医学 | 更新时间：2026-01-09

- 卵圆孔未闭合并隐源性卒中介入封堵与药物的疗效对比
- Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
- 第三军医大学学报 2021年43卷第22期页码：2468-2473
- 作者机构：
  
  1.750004 银川，宁夏医科大学研究生院
  2.712000 陕西咸阳, 咸阳市中心医院神经内科
  3.750004 银川，宁夏医科大学总医院神经内科
  4.750004 银川，宁夏医科大学颅脑实验室
- 作者简介：
  
  [陈桂生，E-mail：chenguisheng1967@163.com CHEN Guisheng, E-mail: chenguisheng1967@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202105100
  中图分类号： R541.1;R654.2;R743.3
- 收稿：2021-05-23，
  
  修回：2021-06-28，
  
  纸质出版：2021-11-30
- 稿件说明：
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康雪, 李海洋, 孙阳阳, 等. 卵圆孔未闭合并隐源性卒中介入封堵与药物的疗效对比[J]. 第三军医大学学报, 2021,43(22):2468-2473.

Xue KANG, Haiyang LI, Yangyang SUN, et al. Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke[J]. Journal of Third Military Medical University, 2021, 43(22): 2468-2473.
康雪, 李海洋, 孙阳阳, 等. 卵圆孔未闭合并隐源性卒中介入封堵与药物的疗效对比[J]. 第三军医大学学报, 2021,43(22):2468-2473. DOI： 10.16016/j.1000-5404.202105100.

Xue KANG, Haiyang LI, Yangyang SUN, et al. Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke[J]. Journal of Third Military Medical University, 2021, 43(22): 2468-2473. DOI： 10.16016/j.1000-5404.202105100.

摘要

目的

比较介入封堵与药物治疗两种方式对卵圆孔未闭（patent foramen ovale

PFO）合并隐源性卒中（cryptogenic stroke

CS）的疗效。

方法

回顾性收集2015年1月至2019年8月于宁夏医科大学总医院神经内科住院的脑梗死或短暂性脑缺血发作（transient ischemic attack，TIA）合并PFO患者病例资料167例，其中PFO介入封堵+抗栓药物治疗80例，仅药物治疗（口服抗血小板聚集

或抗凝药物）87例，平均随访31.6（12~67）个月。根据是否发生终点事件（复发脑梗死、复发TIA和死亡）分为有终点事件组（

=24）和无终点事件组（

=143）。用单因素分析比较两组患者的一般资料，多因素分析筛选患者终点事件复发的独立危险因素；结合受试者工作特征(ROC)曲线分析模型，评估其预测价值。

结果

手术组终点事件的复发率明显低于药物组（χ

=10.959，

=0.001），且PFO为中、大量分流的患者获益较多（χ

=10.26，

=0.001）。单因素结果显示，治疗方法、随访时间及阻塞性睡眠呼吸暂停（obstructive sleep apnea

OSA）病史对有无终点事件发生方面差异有统计学意义（

0.05）。Logistic回归分析显示，影响预后的独立危险因素包括药物治疗(

=8.958，

=0.001，95%

：2.475~32.422)、随访时间(

=1.041，

=0.013，95%

：1.009~1.075)及OSA病史(

=8.117，

=0.001，95%

：2.247~29.324)。ROC曲线分析显示：以药物治疗、随访时间及OSA病史为变量的模型的曲线下面积为0.813(95%

：0.737~0.889，

0.001)；以药物治疗和OSA病史为变量的模型的曲线下面积为0.767(95%

：0.677~0.856，

0.001)；以药物治疗和随访时间为变量的模型的曲线下面积为0.764(95%

：0.674~0.853，

0.001)。

结论

对于PFO合并CS的患者，PFO介入封堵可降低终点事件的复发风险，且PFO为中、大量分流的患者受益较大。积极干预OSA对终点事件的复发有一定的预防作用。

Abstract

Objective

To compare the efficacy of interventional closure versus drug therapy in treatment of patent foramen ovale (PFO) complicated with cryptogenic stroke (CS).

Methods

Clinical data of 167 patients with cerebral infarction or transient ischemic attack (TIA) complicated with PFO admitted in the Department of Neurology

General Hospital of Ningxia Medical University from January 2015 to August 2019 were collected and analyzed retrospectively. Among them

80 (the surgery group) underwent PFO interventional closure and antithrombotic drug administration

and the other 87 (the drug group) only received drug therapy (oral antiplatelet aggregation or anticoagulant drugs). All the patients were followed up for an a

verage of 31.6 (12~67) months. According to occurrence of endpoint events (recurrent cerebral infarction

recurrent TIA and death)

the patients were divided into endpoint event group (

=24) and non-endpoint event group (

=143). Univariate analysis was used to compare the general data between the 2 groups of patients

and multivariate analysis was used to screen independent risk factors for the recurrence of the endpoint events. Receiver operating characteristic (ROC) curve analysis was combined to evaluate the predictive values of obtained risk factors.

Results

The recurrence rate of the endpoint events was significantly lower in the surgery group than the drug group (

Chi

-square=10.959

=0.001)

and the patients with moderate and large shunts of PFO benefited more (

Chi

-square=10.26

=0.001). Univariate analysis showed that the treatment method

follow-up time and history of obstructive sleep apnea (OSA) had statistical significances in the occurrence of endpoint events (

0.05); Multivariate logistic regression analysis showed that the independent risk factors affecting the prognosis of patients were drug therapy (

=8.958

=0.001

95%

: 2.475~32.422)

follow-up time (

=1.041

=0.013

95%

: 1.009~1.075) and a history of OSA (

=8.117

=0.001

95%

: 2.247~29.324). ROC curve analysis showed that the area under the curve was 0.813 (95%

: 0.737 to 0.889

0.001) for the model with drug therapy

follow-up time

and OSA history as variables. The area under the curve was 0.767 (95%

: 0.677~0.856

0.001) for the model with drug therapy and OSA history as variables

and 0.764 (95%

: 0.674~0.853

0.001) f

or the model with drug therapy and follow-up time as variables.

Conclusion

For patients with PFO complicated with CS

interventional closure can reduce the risk of recurrence of the end point events

and the patients with moderate or large number of shunts of PFO benefit more. Active OSA intervention have a certain preventive effect on the recurrence of the endpoint events.

关键词

Keywords

references

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