[1]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].陆军军医大学学报(原第三军医大学学报),2021,43(22):2468-2473.
 KANG Xue,LI Haiyang,SUN Yangyang,et al.Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(22):2468-2473.
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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(/HTML )
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
43卷
期数:
2021年第22期
页码:
2468-2473
栏目:
临床医学
出版日期:
2021-11-30

文章信息/Info

Title:
Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
作者:
康雪 李海洋 孙阳阳 侯莉微 陈桂生
宁夏医科大学:研究生院,总医院神经内科,颅脑实验室;咸阳市中心医院神经内科
Author(s):
KANG Xue LI Haiyang SUN Yangyang HOU Liwei CHEN Guisheng
Graduate School, 3Department of Neurology of General Hospital, 4Craniocerebral Laboratory, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, 750004; 2Department of Neurology, Xianyang Central Hospital, Xianyang, Shaanxi Province, 712000, China
 
关键词:
隐源性卒中卵圆孔未闭封堵术预后
Keywords:
 
分类号:
R541.1; R654.2; R743.3
文献标志码:
A
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(n=24)和无终点事件组(n=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(χ2=10.959,P=0.001),且PFO为中、大量分流的患者获益较多(χ2=10.26,P=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(P<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(OR=8.958,P=0.001,95%CI:2.475~32.422)、随访时间(OR=1.041,P=0.013,95%CI:1.009~1.075)及OSA病史(OR=8.117,P=0.001,95%CI: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%CI:0.737~0.889,P<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%CI:0.677~0.856,P<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%CI:0.674~0.853,P<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:

ObjectiveTo compare the efficacy of interventional closure versus drug therapy in treatment of patent foramen ovale (PFO) complicated with cryptogenic stroke (CS). MethodsClinical 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 average 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 (n=24) and non-endpoint event group (n=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. ResultsThe recurrence rate of the endpoint events was significantly lower in the surgery group than the drug group (Chi-square=10.959, P=0.001), and the patients with moderate and large shunts of PFO benefited more (Chi-square=10.26, P=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 (P<0.05); Multivariate logistic regression analysis showed that the independent risk factors affecting the prognosis of patients were drug therapy (OR=8.958, P=0.001, 95%CI: 2.475~32.422), follow-up time (OR=1.041, P=0.013, 95%CI: 1.009~1.075) and a history of OSA (OR=8.117, P=0.001, 95%CI: 2.247~29.324). ROC curve analysis showed that the area under the curve was 0.813 (95%CI: 0.737 to 0.889, P<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%CI: 0.677~0.856,P<0.001) for the model with drug therapy and OSA history as variables, and 0.764 (95%CI: 0.674~0.853, P<0.001) for the model with drug therapy and follow-up time as variables. ConclusionFor 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.

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更新日期/Last Update: 2021-11-23