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|本期目录/Table of Contents|

反常栓塞与不明原因脑卒中研究的当前问题

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第1期
页码:
1-005
栏目:
专家论坛
出版日期:
2013-02-25

文章信息/Info

Title:
The current issue of paradoxical embolism and cryptogenic stroke
作者:
张玉顺; 何 璐
(西安交通大学第一附属医院心内二科，陕西 西安 710061)
Author(s):
ZHANG Yushun;  HE Lu
(Second Department of Cardiology, First Affiliated Hospital, Medical College of Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)
关键词:
卵圆孔未闭; 反常栓塞; 不明原因脑卒中; 随机对照试验; 治疗
Keywords:
patent foramen ovale;  paradoxical embolism;  cryptogenic stroke;  randomized controlled trials;  treatment
分类号:
R543；R742
DOI:
-
文献标识码:
A
摘要:
卵圆孔是心脏房间隔上胚胎时期遗留下来的一个通道，存在于胎儿期和近1/4的成人，是一个潜在的血栓由自体静脉系统至脑及外周动脉栓塞的途径。正常情况下，卵圆孔未闭（patent foramen ovale，PFO）不引起任何临床症状，但当右心房压力一过性或持续性增高时，可引起心房间右向左分流，身体其他部位的栓子或原位血栓就有可能脱落，造成反常栓塞（paradoxical embolism，PDE）。PDE可引起一系列临床综合征，包括不明原因脑卒中（cryptogenic stroke，CS）、偏头痛、斜卧呼吸-直立型低氧血症、睡眠呼吸暂停综合征、冠脉正常的心肌梗死、脑白质病变及神经减压病所造成的动脉气体栓塞等［1］。但由于主动脉弓的特殊解剖及大脑较其他器官对缺血更敏感，故临床上大部分PDE都表现为短暂性脑缺血发作（transient ischemic attack，TIA）或CS。尽管已有许多令人信服的证据涉及PFO与CS，但其确切发病机制尚未完全明确。本文重点介绍了目前PFO所致PDE并发CS的当前研究现状，尤其是几个随机对照试验（randomized controlled trials，RCT）的结果，以期对我国今后PFO并发CS的治疗提出新的观点。
Abstract:
The foramen ovale is a normal interatrial communication during fetal life that persists after birth in approximately 1/4 adults. The foramen ovale is a potential route for embolic transit from the systemic venous circulation to the brain. In the basal state and peripheral arterial embolism route, patent foramen ovale (PFO) does not cause any clinical symptom. When the pressure of the right atrium transiently or persistently exceeds the pressure of left atrium, righttoleft shunt happens. Emboli or primary thrombus of other body regions is likely to break off, resulting in paradoxical embolism (PDE). PDE has been associated with a series of clinical syndromes including cryptogenic stroke (CS), migraine, systemic hypoxemia from recumbent position breathingorthodeoxia, obstructive sleep apnea syndrome, myocardial infarction with normal coronary, cerebral white matter lesions and arterial gas embolism from neural (cerebral?) decompression illness. However, due to the special anatomy of the aortic arch and brain ischemia, it is more sensitive than other organs. Most PDE assumed transient ischemic attack (TIA) or CS. Although there is convincing circumstantial evidence implicating PFO with CS, the precise role of PFO in the pathogenesis of CS is not still completely understood. This article focuses on the present condition of the study on PDE and CS, especially the results of randomized controlled trials. We expect the above results to propose a new perspective on the treatment of PFO with CS.

参考文献/References

[1]Kim MS,Klein AJ,Carroll JD.Transcatheter closure of intracardiac defects in adults[J].J Interv Cardiol,2007,20(6):524-545.

[2]Cohnheim J.Thrombose und nbolie: Vorlesungen über allgemeine pathologie, Vol 1[M].Berlin:Hirschwald,1877,1:134.

[3]Sacco RL,Ellenberg JH,Mohr JP,et al.Infarcts of undetermined cause:the NNCDS Stroke Date Bank[J].Ann Neurol,1989,25(4):382-390.

[4]Lechat P,Mas JL,Lascault G,et al.Prevalence of patent foramen ovale in patients with stroke[J].N Engl J Med,1988,318(18):1148-1152.

[5]Webster MW,Chancellor AM,Smith HJ,et al.Patent foramen ovale in young stroke patients[J].Lancet,1988,2(8601):11-12.

[6]Di Tullio M,Sacco RL,Gopal A,et al.Patent foramen ovale as a risk factor for cryptogenic stroke[J].Ann Intern Med,1992,117(6):461-465.

[7]Handke M,Harloff A, Olschewski M.Patent foramen ovale and cryptogenic stroke in older patients[J].N Engl J Med,2007,357(22):2262-2268.

[8]Overell JR, Bone I,Lees KR,et al.Interatrial septal abnormalities and stroke:a metaanalysis of casecontrol studies[J].Neurolog,2000,55(8):1172-1179.

[9]Cramer SC,Rordorf G,Maki JH,et al.Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke(PELVIS)study[J].Stroke,2004,35(1):46-50.

[10]Meissner I,Khandheria BK,Heit JA,et al.Patent foramen ovale:innocent or guilty?Evidence from a prospective populationbased study[J].J Am Coll Cardiol,2006,47(2):440-445.

[11]Mohr J,Thompson JLP,Lazar RM,et al.for the WarfarinAspirin Recurrent Stroke Study Group.A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke[J].N Engl J Med,2001,345(20):1444-1451.

[12]Homma S,Sacco RL,Tullio MR,et al.for the PFO in Cryptogenic Stroke Study(PICSS)Investigators. Effect of medical treatment in stroke patients with patent foramen ovale:patent foramen ovale in cryptogenic stroke study[J].Circulation,2002,105(22):2625-2631.

[13]Bridges ND,Hellenbrand W,Latson L, et al.Transcatheter closure of patent foramen ovale after presumed paradoxical embolism[J].Circulation,1992,86(6):1902-1908.

[14]Windecker S,Wahl A,Nedeltchev K,et al.Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke[J].J Am Coll Cardiol,2004,44(4):750-758.

[15]Khairy P,O’Donmell CP,Landzberg MJ.Transcatheter cloure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli:asystematic review[J].Am Intern Med,2003,139(9):753-760.

[16]Furlan AJ,Reisman M,Massaro J,et al.Study design of the CLOSURE I trial:a prospective,multicenter,randomized,controlled trial to evaluate the safety and efficacy of the StarFlex septal closure system versus best medical therapy in patients with stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale[J].Stroke,2010, 41(12):2872-2883.

[17]Kitsios GD,Dahabreh IJ,Abu Dabrh AM,et al.Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence[J].Stroke,2012,43(2):422-431.

[18]Ford MA,Reeder GS,Lennon RJ,et al.Percutaneous device closure of patent foramen ovale in patients with presumed cryptogenic stroke or transient ischemic attack:the Mayo Clinic experience[J].JACC Cardiovasc Interv,2009,2(5):404-411.

[19]Fischer D,Haentjes J,Klein G,et al.Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: procedural and followup results after implantation of the Amplatzer occluder device[J].J Interv Cardiol,2011,24(1):85-91.

[20]Khattab AA,Windecker S,Juni P,et al.Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO occluder with medical treatment in patients with cryptogenic embolism(PCtrial):rationale and design[J].Trials,2011,12:56.

备注/Memo

备注/Memo:
收稿日期：2012-11-29.作者简介：张玉顺，主任医师，现任西安交通大学医学院第一附属医院心血管病医院副院长，心内科和周围血管科主任。中国老年保健医学研究会心脏学会常务委员，中国医师协会心血管分会委员，结构性心脏病工作委员会副主任委员，亚太心脏联盟结构性心脏病分会副主任委员兼秘书长。《心脏杂志》副主编，《中国医师进修杂志》、《中国循证心血管医学》等杂志编委，主编及参编各类著作11部，发表文章180余篇。参加国家科技攻关计划2项，国家“八五”及“九五” 攻关课题等。获国家科技进步二等奖1项。擅长各种结构性心脏病的介入性诊断与治疗，以及对反常栓塞与心脑血管疾病、肺动脉高压等的研究。Email：zys2889@sina.com
更新日期/Last Update: 2013-03-20