卵圆孔未闭与隐源性卒中

Patent foramen ovale and cryptogenic stroke

隐源性卒中占所有缺血性卒中的25％～40％，其病因诊断和治疗一直是临床研究者们努力的方向。其中，卵圆孔未闭（patent foramen ovale, PFO）与隐源性卒中的关系广受争议，一直是研究的热点。病例对照研究表明，与普通人群相比，隐源性卒中患者中PFO患病率显著增高。不过，前瞻性研究显示，单纯PFO并不会增高隐源性卒中发生率，只有在PFO与其他一些高危因素共存时才会显著增高缺血性卒中风险。 PFO的治疗选择包括抗血小板药、抗凝药、经皮介入封堵术和开胸封堵术。近年来，3项比较PFO封堵术与药物预防隐源性卒中复发的大样本临床试验结果已发表，使得卒中二级预防指南得以更新。文章就PFO与隐源性卒中的联系、PFO相关隐源性卒中的高危特征以及二级预防治疗方面的研究进展进行了综述。

Cryptogenic stroke accounts for 25%to40% of all ischemic strokes.Itsetiologic diagnosis and treatment have been the direction of clinical researchers. Among them, the relationship between patent foramen ovale （PFO） and cryptogenic stroke has always been widely disputed and has been the focus of research. A case-control study has shown that the PFO prevalence in patients with cryptogenic stroke is significantly higher compared with the general population. How ever, prospective studies have shown that the pure PFO does not increase the incidence of cryptogenic stroke, only when the PFO and other high risk factors coexist, will the risk of ischemic stroke be significantly high. The treatment options of PFO include anti-platelet drugs, anticoagulants, percutaneous interventional closure, and surgical closure. In recent years, the results of 3 large sample clinical trials about PFO closure vs. drug prevention of recurrence of cryptogenic stroke have been published, making the secondary stroke prevention guidelines to be updated. This article reviews the correlation between PFO and cryptogenic stroke, high-risk features of PFO-related cryptogenic stroke, and research progress in the secondary prevention and treatment.