两种造影剂在经颅多普勒超声诊断卵圆孔未闭中的诊断阳性率对比

Comparison of two contrast agents for diagnosis of patent foramen ovale by contrast transcranial Doppler

目的 比较生理盐水-气体混合液（AS）和生理盐水-气体-血混合液（ASb）这两种造影剂在经颅多普勒超声（c-TCD）诊断卵圆孔未闭（PFO）方面的差异。方法 收集2015年11月~2016年1月在我院TCD室行c-TCD检查患者248例，通过掷硬币法决定AS或ASb这两种造影剂使用的先后顺序。然后分别均在不伴Valsalva动作（VM）与伴VM情况下，注入造影剂（CA），通过观察TCD频谱，记录CA注射后25 s内微泡数目及第一个微泡出现的时间。具体操作方法如下：（1）9 mL生理盐水混合1 mL空气不伴VM（AS不伴VM）；（2）9 mL生理盐水混合1 mL空气伴VM（AS伴VM）；（3）9 mL生理盐水、1滴患者回抽血液混合1 mL空气不伴VM（ASb不伴VM）；（4）9 mL生理盐水、1滴患者回抽血液混合1 mL空气伴VM（ASb伴VM）。上述每种方法重复2次，且每个过程间隔至少5 min。根据微泡数量对PFO分流程度进行分级：0级，阴性；Ⅰ级，1~10个微泡；Ⅱ级，>10个微泡但未形成“雨帘”；Ⅲ级，形成雨帘状。结果 AS不伴VM、AS伴VM、ASb不伴VM和ASb伴VM检查的阳性率分别是10.9%、23.8%、12.1%、25.8%。AS伴VM组发泡阳性率较AS不伴VM组显著增高，具有统计学差异（23.8% vs 10.9%，P=0.001）；ASb伴VM组发泡阳性率较ASb不伴VM组显著增高，具有统计学差异（25.8% vs 12.1%，P=0.001）；ASb不伴VM组发泡阳性率与AS不伴VM 组相比差异无统计学意义（12.1% vs 10.9%，P=0.250）；ASb 伴 VM 组发泡阳性率与 AS 伴 VM 组相比差异无统计学意义（25.8% vs 23.8%，P=0.125）。结论 应用c-TCD检测PFO时VM能够提高诊断阳性率，而AS与ASb这两种造影剂在诊断PFO阳性率方面无明显差异。

Objective To compare agitated saline solution(AS) and the mixture of AS with blood(ASb) as the contrast agents in contrast transcranial Doppler(c-TCD) in the diagnosis of patent foramen ovale(PFO). Methods We recruited 248 consecutive patients for c-TCD examination between November 2015 and January 2016, and the sequence of the use of AS(9 m L saline solution mixed with 1 m L air) and ASb(9 m L saline solution and a drop of the patient's blood mixed with 1 m L air) was determined by coin-tossing method. Before the examination, the contrast agent was injected with or without Valsalva maneuvers(VM), and the number of microbubbles within 25 s after the contrast agent injection and the time of first appearance of microbubbles were recorded by observing the TCD spectrum. Each injection was repeated twice and the interval between tests was at least 5 min. We classified PFO according to the number of microbubbles into negative(no microbubble),grade I(1-10 microbubbles), grade II(>10 microbubbles but no curtain), and grade III(with curtain).Results The positivity rates in diagnosis with AS without VM, AS with VM, ASb without VM, and ASb with VM tests were 10.9%, 23.8%, 12.1% and25.8%, respectively. AS with VM test had a higher positive rate than AS without VM test(23.8% vs 10.9%, P=0.001), and ASb with VM test had a higher positive rate than ASb without VM test(25.8% vs 12.1%, P=0.001). The positive rates were similar between ASb without VM and AS without VM test(12.1% vs 10.9%, P=0.250) and between ASb with VM test and AS with VM test(25.8% vs 23.8%, P=0.125). Conclusion VM can improve the positive rate of PFO diagnosis in c-TCD examination, and the positive rates are comparable between examinations using the contrast agents AS and ASb.