不明原因缺血性卒中合并卵圆孔未闭磁共振弥散加权成像梗死病灶特点及发病机制分析

摘要

Objective To analyze the DWI-MRI infarction lesion patterns and pathogenic mechanism of cryptogenic ischemic stroke combined with patent foramen ovale ( PFO) .Methods 70 ischemic stroke patients who accorded with inclusion and exclusion criteria and were admitted into the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University from January 2004 to September 2012 were enrolled in the study.According to whether PFO occurred, the patients were divided into PFO group (n=27) and non-PFO group (n=43) .General data and imaging data were collected and compared, and transoesophageal echocardiography results of PFO group were recorded.Results PFO group was lower in the incidence of infarction lesion in cortex or under cortex and higher in the incidence of infarction lesion of cardiac embolism than non-PFO group (P<0.05) .The two groups were not significantly different in the incidence rates of large-area infarction lesion in cortex and under cortex, multiple infarction lesions in one circulating blood supply area, multiple infarction lesions in unilateral cerebral circulating blood supply area, multiple infarction lesions in bilateral cerebral circulating blood supply area, infarction lesions in anterior cerebral artery blood supply area, middle cerebral artery blood supply area, vertebrobasilar artery blood supply area, anterior circulation system, posterior circulation system, anterior&posterior circulation system (P>0.05) .Conclusion Infarction nidus of cardiogenic embolism may be related with cryptogenic ischemic stroke combined with PFO, and its mechanism of stroke may be paradoxical embolism.%目的：分析不明原因缺血性卒中合并卵圆孔未闭（PFO）磁共振弥散加权成像（DWI－MRI）上的梗死病灶特点，探讨不明原因缺血性卒中合并PFO的发病机制。方法选取2004年1月—2012年9月温州医科大学附属第一医院神经内科收治的符合纳入与排除标准的缺血性卒中患者70例为研究对象。按照是否合并PFO分为PFO组（27例）和非PFO组（43例）。收集并比较患者的临床资料、影像学资料，记录PFO组患者经食管心脏超声结果。结果 PFO组皮层或皮层下梗死病灶发生率低于非PFO组，符合心源性栓塞形式梗死病灶发生率高于非PFO组（ P＜0.05）。两组皮层－皮层下大片梗死病灶、一个循环供血区多发梗死病灶、单侧大脑循环供血区多发梗死病灶、双侧大脑循环供血区多发梗死病灶、大脑前动脉供血区梗死病灶、大脑中动脉供血区梗死病灶、椎－基底动脉系统供血区梗死病灶、前循环系统梗死病灶、后循环系统梗死病灶、前＋后循环系统梗死病灶发生率比较，差异无统计学意义（P＞0.05）。结论符合心源性栓塞形式梗死病灶与不明原因缺血性卒中合并PFO可能有关，推测其卒中机制可能为反常性栓塞。