卵圆孔未闭相关卒中的精准诊断与风险分层策略

doi:10.3969/j.issn.1673-5765.2025.11.008

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (11): 1394-1401.DOI: 10.3969/j.issn.1673-5765.2025.11.008

卵圆孔未闭相关卒中的精准诊断与风险分层策略

刘君英^1*，苏颖^2*，江红亮³，曹黎明⁴（*第一作者）

1 深圳 518035 深圳市第二人民医院（深圳大学第一附属医院）内分泌科
2 佛山市高明区人民医院神经内科
3 益阳市第三人民医院神经内科
4 深圳市第二人民医院（深圳大学第一附属医院）神经内科

收稿日期:2025-08-09 修回日期:2025-11-04 接受日期:2025-11-11 出版日期:2025-11-20 发布日期:2025-11-20
通讯作者: 曹黎明 caolm-2007@163.com
基金资助:
2025年度深圳市神经系统疾病临床医学研究中心开放课题（SCRCND202503）
深圳市卫生健康菁英人才培养计划（2024XKG021）
深圳市医防融合（神经系统疾病）项目（深卫健体改〔2019〕25号）

Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke

LIU Junying^1*, SU Ying^2*, JIANG Hongliang³, CAO Liming⁴(*contributed equally)

1 Department of Endocrinology, Shenzhen Second People’s Hospital (The First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
2 Department of Neurology, Foshan Gaoming District People’s Hospital, Foshan 528599, China
3 Department of Neurology, Yiyang Third People’s Hospital, Yiyang 413002, China
4 Department of Neurology, Shenzhen Second People’s Hospital (The First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China

Received:2025-08-09 Revised:2025-11-04 Accepted:2025-11-11 Online:2025-11-20 Published:2025-11-20
Contact: CAO Liming, E-mail: caolm-2007@163.com

摘要/Abstract

摘要： 卵圆孔未闭（patent foramen ovale，PFO）是成人最常见的先天性心脏异常之一。作为一种可干预的隐源性卒中病因，PFO导致的缺血性卒中具有复发率高、神经功能损伤严重的特点，且存在潜在多器官栓塞风险。精准识别PFO相关卒中患者并采取经导管PFO封堵术治疗，可显著改善神经功能预后。PFO可通过反常栓塞、原位血栓形成等机制引起卒中。因此，针对PFO相关卒中的管理需综合PFO的解剖与功能特征、卒中临床表现等信息，借助反常栓塞风险评分系统、PFO相关卒中因果可能性分类系统进行风险评估，并制订合理的个体化治疗方案（如药物、介入及手术等治疗措施），以降低卒中复发风险、改善患者预后。本文综述了PFO相关卒中的风险评估、影像学特征及诊断策略，旨在为临床精准识别及干预PFO相关卒中、降低卒中复发风险提供依据。

文章导读： 本文聚焦卵圆孔未闭相关卒中的风险评估和精准诊断，系统综述风险评估工具（RoPE评分系统、PASCAL分类系统）、多模态影像诊断路径及未来智能化方向，为临床识别高危患者、优化干预策略提供参考。

关键词: 卵圆孔未闭; 隐源性卒中; 诊断流程; 风险分层; 多模态影像

Abstract: Patent foramen ovale (PFO) is one of the most common congenital cardiac anomalies in adults. As an intervenable cause of cryptogenic stroke, ischemic stroke induced by PFO is characterized by a high recurrence rate, severe neurological impairment, and potential risk of multi-organ embolism. Precise identification of PFO-related stroke patients and treatment with transcatheter PFO closure can significantly improve neurological prognosis. PFO can cause stroke through mechanisms such as paradoxical embolism and in-situ thrombosis. Therefore, the management of PFO-related stroke requires integrating information including PFO anatomical and functional characteristics as well as clinical manifestations of stroke. Risk assessment should be performed using the risk of paradoxical embolism score and the PFO-associated stroke causal likelihood classification system, followed by the formulation of reasonable and individualized treatment plans (such as drug treatment, interventional therapy, and surgical treatment) to reduce stroke recurrence risk and enhance patient outcomes. This article reviews the risk assessment, imaging characteristics, and diagnostic strategies for PFO-related stroke, aiming to provide evidence for precise identification and intervention of PFO-related stroke and reducing stroke recurrence.

Key words: Patent foramen ovale; Cryptogenic stroke; Diagnostic process; Risk stratification; Multimodal imaging

中图分类号:

刘君英, 苏颖, 江红亮, 曹黎明. 卵圆孔未闭相关卒中的精准诊断与风险分层策略[J]. 中国卒中杂志, 2025, 20(11): 1394-1401.

LIU Junying, SU Ying, JIANG Hongliang, CAO Liming. Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke[J]. Chinese Journal of Stroke, 2025, 20(11): 1394-1401.

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卵圆孔未闭相关卒中的精准诊断与风险分层策略

Precision Diagnosis and Risk Stratification Strategies for Patent Foramen Ovale-Related Stroke

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