卵圆孔未闭封堵术与药物治疗在中青年隐源性脑梗死伴卵圆孔未闭患者二级预防中应用效果的对比研究

Application Effect of Patent Foramen Ovale Closure and Drug Therapy on Secondary Prevention in Young and Middleaged Cryptogenic Cerebral Infarction Patients Accompanied with Patent Foramen Ovale:a Comparative Study

目的比较卵圆孔未闭(PFO)封堵术与药物治疗在中青年隐源性脑梗死(CCI)伴PFO患者二级预防中的应用效果。方法选取2010年1月-2018年5月在空军军医大学西京医院神经内科住院的CCI伴PFO患者163例,根据治疗方法不同分为手术组67例和药物组96例。手术组患者采取PFO封堵术治疗,药物组患者口服抗血小板聚集药物或抗凝药。比较两组患者美国国立卫生研究院卒中量表(NIHSS)评分、卵圆孔特征、随访时间及缺血性脑血管事件发生率,比较有无缺血性脑血管事件患者临床特征、NIHSS评分、卵圆孔特征及治疗方法;中青年CCI伴PFO患者缺血性脑血管事件影响因素分析采用多元Cox比例风险回归分析,绘制Kaplan-Meier生存曲线以评价手术组和药物组患者无缺血性脑血管事件生存状况。结果(1)两组患者NIHSS评分、安静状态下卵圆孔分流方向、随访时间、病死率及短暂性脑缺血发作(TIA)发生率比较,差异无统计学意义(P>0.05);手术组患者PFO直径大于药物组,安静状态下卵圆孔分流分级2级者所占比例高于药物组,脑梗死再发率及缺血性脑血管事件总发生率低于药物组(P<0.05)。(2)有无缺血性脑血管事件患者性别、糖尿病病史、冠心病病史、偏头痛病史、高同型半胱氨酸血症发生率、动脉炎发生率、深静脉血栓形成发生率、NIHSS评分、PFO直径及安静状态下卵圆孔分流方向、分流分级比较,差异无统计学意义(P>0.05);有无缺血性脑血管事件患者年龄、高血压病史、吸烟史、饮酒史、高脂血症发生率、房间隔瘤发生率及治疗方法比较,差异有统计学意义(P<0.05)。(3)多元Cox比例风险回归分析结果显示,行药物治疗的中青年CCI伴PFO患者缺血性脑血管事件发生风险是行PFO封堵术患者的6.120倍[95%CI(1.450,17.420),P<0.05]。(4)Kaplan-Meier生存曲线显示,手术组患者无缺血性脑血管事件生存状况优于药物组(P<0.05)。结论行药物治疗的中青年CCI伴PFO患者缺血性脑血管事件发生风险是行PFO封堵术患者的6.120倍,因此PFO封堵术在中青年CCI伴PFO患者二级预防中的应用效果更优。

Objective To compare the application effect of patent foramen ovale(PFO)closure and drug therapy on secondary prevention in young and middle-aged cryptogenic cerebral infarction(CCI)patients accompanied with PFO.Methods From January 2010 to May 2018,a total of 163 young and middle-aged CCI inpatients accompanied with PFO were selected in the Department of Neurology,Xijing Hospital of Air Force Military Medical University,and they were divided into operation group(n=67)and drug group(n=96)according to different therapeutic methods.Patients in operation group received PFO closure,while patients in drug group received oral anti-platelet drugs or anticoagulants.NIHSS score,characteristics of foramen ovale,duration of follow-up and incidence of ischemic cerebrovascular events were compared between the two groups;clinical features,NIHSS score,characteristics of foramen ovale and therapeutic method were compared between patients with and without ischemic cerebrovascular events;multivariate Cox proportional hazard regression analysis was used to analyze the influencing factors of ischemic cerebrovascular events in young and middle-aged CCI patients accompanied with PFO,and Kaplan-Meier survival curve was drawn to evaluate the survival status in patients without ischemic cerebrovascular events between operation group and drug group.Results(1)There was no statistically significant difference in NIHSS score,the shunt direction of foramen ovale in quirt state,duration of follow-up,fatality rate or incidence of TIA between the two groups(P>0.05);diameter of PFO in operation group was statistically significantly larger than that in drug group,proportion of patients with 2-grade shunt of foramen ovale in quirt state in operation group was statistically significantly higher than that in drug group,while recurrence rate of cerebral infarction and incidence of ischemic cerebrovascular events in operation group were statistically significantly lower than those in drug group(P>0.05).(2)There was no statistically significant difference in gender,history of diabetes,CHD or migraine,incidence of hyperhomocysteinemia,arteritis or deep vein thrombosis,NIHSS score,diameter of PFO,shunt direction of foramen ovale at static condition or shunt grade of foramen ovale between patients with and without ischemic cerebrovascular events(P>0.05),while there was statistically significant difference in history of hypertension,smoking and drinking,incidence of hyperlipidemia,atrial septal tumor and therapeutic methods between patients with and without ischemic cerebrovascular events,respectively(P<0.05).(3)Multivariate Cox proportional hazard regression analysis results showed that,risk of ischemic cerebrovascular events in patients received drug therapy was 6.120 times[95%CI(1.450,17.420)]than that in patients received PFO closure.(4)Kaplan-Meier survival curve showed that,survival status in patients without ischemic cerebrovascular events in operation group was statistically significantly better than that in patients without ischemic cerebrovascular events in drug group(P<0.05).Conclusion Risk of ischemic cerebrovascular events in patients received drug therapy is 6.120 times than that in patients received PFO closure,therefore,application effect of PFO closure is more better than drug therapy on secondary prevention in young and middle-aged CCI patients accompanied with PFO.