卵圆孔未闭封堵术与阿司匹林治疗对伴有卵圆孔未闭的缺血性脑血管病再发的影响

目的 探讨卵圆孔未闭（patent foramen ovale，PFO）封堵术与阿司匹林治疗对伴有卵圆孔未闭的缺血性脑血管病再发的影响。方法 连续选取首都医科大学宣武医院神经内科住院的55岁以下的缺血性卒中或者短暂性脑缺血发作（transient ischemic attack，TIA）患者，将其中通过经食管超声心动图（transesophagealechocardiography，TEE）检查证实存在PFO的45例患者根据治疗方式分为两组，阿司匹林治疗组（药物组）38例，经皮PFO封堵术组（手术组）7例，比较两组缺血性脑血管病的复发情况。结果 两组PFO直径无差别（P =0.461）。治疗后3个月和6个月内，手术组无复发患者，药物组复发率分别为7.9%和13.1%，两组3个月及6个月复发率均无明显差异（P =0.595，0.411）。治疗6个月内，药物组有5例患者出现复发情况，其中3例是小型PFO（直径≤1.9mm），而手术组中的小型PFO患者均无复发。结论 尚不能确定经皮PFO封堵术与阿司匹林治疗对缺血性脑血管病复发影响的差异，但封堵术后无复发病例的疗效趋势及封堵术对小型PFO的意义却值得关注。

Effect of Percutaneous Closure of Patent Foramen Ovale(PFO)or Aspirin Treatment to Ischemic Cerebrovascular Diseases Recurrence of Patients with PFO

Objective To observe the effect ofpercutaneous closure of patent foramen ovale （PFO） or aspirin treatment to ischemic cerebrovascular diseases recurrence of patients with PFO. Methods The resident patients whose age〈55 years with cerebral infarction or transient ischemic attack （TIA） in the department of neurology of XuanWu hospital were selected continuously. All patients were diagnosed by transesophageal echocardiography（TEE）. Finally, 45 patients with PFO were researched. One group treated by aspirin were 38 persons, the other treated by percutaneous PFO closure were 7. The recurrence rate of ischemic cerebrovascular diseases of two groups were compared. Results The size of PFO was not significant difference between two groups（P=0.461）. After 3 months and 6 months treatment, the group of percutaneous PFO closure had no recurrence, the recurrence rate of the group treated by aspirin were 7.89% and 13.12%, respectively. There was no significant difference between two groups（P=0.595, 0.411）. After 6 months, there were 5 recurrences in the aspirin group, including 3 patients with small PFO（PFO_〈I.9mm）, but there was no recurrence in the group closure. Conclusion The difference of recurrence rate between percutaneous PFO closure and aspirin was not clear. But after percutaneous PFO closure, there was no recurrence. There was great significance of percutaneous PFO closure for treating the patients with small PFO.