首页|卵圆孔封堵对卵圆孔未闭并发隐源性卒中患者血同型半胱氨酸水平的影响

卵圆孔封堵对卵圆孔未闭并发隐源性卒中患者血同型半胱氨酸水平的影响

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目的 探讨卵圆孔封堵对卵圆孔未闭(PFO)并发隐源性卒中(CS)患者血同型半胱氨酸(Hcy)水平的影响.方法 纳入2018年10月至2022年12月郑州大学附属郑州中心医院CS患者981例,根据发泡实验心脏右向左分流量分为0级(不合并PFO,464例)、Ⅰ级(194例)、Ⅱ级(105例)和Ⅲ级(218例)4组,比较4组间血Hcy水平差异.对于CS合并Ⅱ~Ⅲ级右向左分流者,根据其意愿分为手术组(114例)和非手术组(209例),手术组行卵圆孔封堵,比较术后半年血Hcy水平降低值.手术组封堵前分别于右心房、左心房,封堵后10 min分别于右心房、股动脉抽血测Hcy水平,比较血Hcy水平差异.手术组封堵后半年,复查发泡实验、血Hcy水平,根据发泡结果分为无残余分流98例、轻度残余分流8例和中重度残余分流8例,比较血Hcy水平差异.符合正态分布的计量资料以均数±标准差((x)±s)表示,组间比较采用参数检验;不符合正态分布的计量资料用M(Q1,Q3)表示,组间比较采用非参数检验.结果 随CS患者合并右向左分流分级增加,血Hcy水平呈递增趋势,组间比较差异有统计学意义[0级:14.70(11.53,18.93)μmol/L,Ⅰ级:13.00(10.98,19.00)μmol/L,Ⅱ 级:17.00(13.95,24.00)μmol/L,Ⅲ级:21.00(18.70,25.08)μmol/L,H=153.628,P<0.01].CS合并Ⅱ~Ⅲ级右向左分流手术组患者术后半年血Hcy水平降低值高于非手术组,差异有统计学意义[5.00(3.00,7.00)μmol/L 比 3.35(2.00,5.93)μmol/L,Z=-2.665,P<0.05].手术组封堵后10 min股动脉中Hcy水平均低于术前右心房、左心房和术后右心房中Hcy水平.手术组封堵后半年,无残余分流和轻度残余分流患者的血Hcy水平降低值均高于中重度残余分流患者[7.20(7.20,13.00)μmol/L 和 7.20(3.75,7.20)μmol/L 比 2.00(1.00,4.50)μmol/L,H=20.247,P<0.01].结论 PFO的存在可能升高血Hcy水平,卵圆孔封堵可降低PFO并发CS患者血Hcy水平.
Effect of foramen ovale occlusion on serum homocysteine level in patients with patent foramen ovale complicated with cryptogenic stroke
Objective To explore the effect of foramen ovale occlusion on homocysteine(Hcy)levels in patients with patent foramen ovale(PFO)complicated with cryptogenic stroke(CS).Methods The 981 patients with CS in Zhengzhou Central Hospital from October 2018 to December 2022 were retro-spectively analyzed and divided into 0,1,2,and 3 groups according to the right-to-left shunt volume of the foaming experimental heart.The Hcy levels were compared among the four groups.For those with CS com-bined with medium-large right-to-left shunt,the patients were divided into blocked and non-blocked groups according to their wishes,and the serum Hey reduction values were compared after 6 months.In the blocked group,Hcy levels were measured in the right atrium and left atrium before blocking,and in the right atrium and femoral artery after blocking,and the differences were compared.In the blocked group,the foaming test was repeated 6 months after the operation,and the results were classified as no residual shunt,mild residual shunt,and moderate to severe residual shunt,and the differences in Hey levels were compared after 6 months.Normally distributed quantitative data were expressed as the mean plus or minus the standard deviation((x)±s),and group comparisons were made using parametric tests.Non-normally dis-tributed quantitative data were expressed as M(Q1,Q3),and group comparisons were made using non-par-ametric tests.Results The serum Hcy level in CS patients with PFO(grade Ⅱ:17 μmol/L;grade Ⅲ:21 μmol/L)was significantly higher than that in patients without PFO(grade 0:14.7 μmol/L)(P<0.05).The decrease of blood Hcy in PFO operation group(5 μmol/L)was significantly higher than that in non-operation group(3.35 μmol/L)(P<0.05).Conclusion The presence of PFO may elevate the ser-um level of Hcy,and PFO occlusion may reduce the level of Hcy in CS patients.

Foramen ovale patentCryptogenic strokeHomocysteine

张涛、豆倩云、余欣、闫振富、毛治尉、王平、王东伟、谢宜旭

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郑州大学附属郑州中心医院心血管内科,郑州 450007

郑州大学附属郑州中心医院心血管外科,郑州 450007

卵圆孔未闭 隐源性卒中 同型半胱氨酸

河南省医学科技攻关计划

2018010047

2024

中华实验外科杂志
中华医学会

中华实验外科杂志

CSTPCD
影响因子:0.759
ISSN:1001-9030
年,卷(期):2024.41(6)
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