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中华心脏与心律电子杂志 ›› 2025, Vol. 13 ›› Issue (03) : 149 -155. doi: 10.3877/cma.j.issn.2095-6568.2025.03.004

综述

卵圆孔未闭相关非卒中性疾病研究进展
李志强1, 王诚2,()   
  1. 1214000 无锡,无锡市锡山人民医院心血管内科
    2221000 徐州,徐州医科大学附属医院心血管内科
  • 收稿日期:2025-02-26 出版日期:2025-09-25
  • 通信作者: 王诚

Research advances in patent foramen oval related non-apoplectic disease

Zhiqiang Li1, Cheng Wang2,()   

  1. 1Department of Cardiology, Xishan People's Hospital, Wuxi 214000, China
    2Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
  • Received:2025-02-26 Published:2025-09-25
  • Corresponding author: Cheng Wang
引用本文:

李志强, 王诚. 卵圆孔未闭相关非卒中性疾病研究进展[J/OL]. 中华心脏与心律电子杂志, 2025, 13(03): 149-155.

Zhiqiang Li, Cheng Wang. Research advances in patent foramen oval related non-apoplectic disease[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(03): 149-155.

卵圆孔未闭(PFO)是一种常见的先天性心脏病,近年来研究发现其与多种非卒中性疾病存在关联,如偏头痛、减压病、斜卧呼吸-直立性低氧血症及非脑血管周围栓塞等。本文探讨了PFO相关非卒中性疾病的流行病学特征、病理生理机制、诊断与评估方法以及治疗策略等方面的最新进展,旨在为临床诊疗提供参考,并对未来研究方向进行展望。

表1 PFO封堵术治疗偏头痛相关临床研究一览
作者,发表年份 研究类型 样本量 主要研究结果 主要研究结论
季春影等33,2024 回顾性单臂观察性研究 106 封堵术后1年,不同残余分流级别(0~Ⅲ级)患者的偏头痛缓解率存在显著差异[18.75%(Ⅲ级)对58%~69%(0~Ⅱ级),P=0.02] PFO封堵术后0~Ⅱ级残余分流患者偏头痛明显缓解,Ⅲ级残余分流患者偏头痛无明显缓解
Mas等28,2021 开放标签RCT(CLOSE-MIG) 145 平均5年随访显示封堵组和对照组患者偏头痛平均年发作次数及完全停止率差异均无统计学意义(P<0.05) 在PFO-AS合并偏头痛患者中,PFO封堵术联合抗血小板治疗未能减少偏头痛平均年发作次数
He等29,2020 前瞻性队列研究结合单臂试验 103 封堵术后6个月时MA患者的MIDAS和HIT-6评分显著降低(P<0.05) PFO封堵术可明显缓解MA患者的头痛症状
Tobis等26,2017 双盲RCT(PREMIUM) 230 封堵组与假手术组患者在主要终点应答率(发作减少50%)上差异无统计学意义(P=0.32),但次要终点显示封堵组每月偏头痛天数显著减少和完全缓解率提高(P<0.05),且在MA亚组中封堵组的应答率和完全缓解率也显著优于假手术组(P<0.05) PFO封堵术未达到主要终点(应答率),但显著减少每月偏头痛天数,且少数患者完全缓解。PFO封堵术可能对MA患者有效
Mattle等27,2016 开放标签RCT(PRIMA) 107 封堵组在主要终点(每月偏头痛减少)上与对照组差异无统计学意义(P=0.17),但在偏头痛天数减少≥50%、MA天数和发作次数减少方面均显著优于对照组(均P<0.05) PFO封堵术未显著减少每月偏头痛发作天数,但对MA亚组可能有效
Xing等32,2016 非随机对照试验(EASTFORM) 241 封堵组术后12个月HIT-6评分显著低于对照组(P<0.001),且73.6%患者评分较术前显著降低 PFO封堵术是一种治疗中国人群偏头痛的有效方法
Dowson等25,2008 双盲RCT(MIST) 147 封堵组与假手术组在主要终点(偏头痛停止)上差异无统计学意义,但探索性分析显示封堵组总偏头痛天数显著减少(P=0.027) PFO封堵术未显示对难治性偏头痛具有显著疗效
Luermans等30,2008 前瞻性观察性研究 92 封堵术后偏头痛患病率由28.6%降至10.7%(P=0.001),MA比例由11.9%降至2.4%(P=0.02) PFO封堵术与偏头痛(尤其是MA)患病率的降低有关
Reisma等31,2005 回顾性单臂观察性研究 162 封堵术后56%反常性脑栓塞患者偏头痛完全缓解,14%显著缓解,且偏头痛月均发作次数减少80%(P<0.001) PFO封堵术显著减少反常性脑栓塞患者的偏头痛发作频率
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