经颅多普勒发泡试验联合右心声学造影诊断青年偏头痛合并卵圆孔未闭的应用价值

Application value of TCD foaming test combined with right echocardiography in diagnosis of yong migraine patients with patent foramen ovale

目的探讨经颅多普勒(transcranial doppler,TCD)发泡试验联合右心声学造影(right echocardiography,RCAC)诊断青年偏头痛合并卵圆孔未闭(patent foramen ovale,PFO)的效能。方法选择2020年1月至2022年12月商丘市第一人民医院收治的青年偏头痛患者120例,均行TCD发泡试验及RCAC检查,以经食道心脏超声(transesophageal cardiac ultrasound,TEE)为金标准,比较TCD发泡试验、RCAC单独及联合检查的灵敏度、特异度。结果120例青年偏头痛患者经TEE检查确诊PFO 66例,确诊率55.00%。TCD发泡试验诊断PFO 61例,与金标准比较,符合率为74.17%;RCAC诊断PFO 58例,与金标准比较,符合率为75.00%;TCD发泡试验联合RCAC诊断PFO 65例,与金标准比较,符合率为94.17%。单独TCD发泡试验灵敏度、特异度、阳性预测值、阴性预测值分别为72.73%、75.96%、78.69%、69.49%,单独RCAC检查灵敏度、特异度、阳性预测值、阴性预测值分别为71.21%、79.63%、81.03%、69.35%,两者联合的灵敏度、特异度、阳性预测值、阴性预测值分别为93.94%、94.44%、95.38%、92.73%,高于单独应用(P<0.05)。结论青年偏头痛患者应用TCD发泡试验联合RCAC检查可提高PFO诊断的准确性。

Objective To explore the efficacy of transcranial Doppler(TCD)foaming test combined with right echocardio⁃graphy(RCAC)in the diagnosis of yong migraine patients with patent foramen ovale(PFO).Methods Totally 120 young migraine patients admitted from January 2020 to December 2022 were selected to undergo TCD foam test and RCAC exami⁃nation.Transesophageal cardiography(TEE)was used as the gold standard to compare the sensitivity and specificity of TCD foam test,RCAC alone and combined examination.Results Among 120 young migraine patients,66 cases were di⁃agnosed with PFO by TEE examination,the diagnosis rate was 55.00%.61 cases of PFO were diagnosed by TCD foam test,and the coincidence rate was 74.17%compared with the gold standard.58 cases of PFO were diagnosed by RCAC,and the coincidence rate was 75.00%compared with the gold standard.65 cases of PFO were diagnosed by TCD foaming test combined with RCAC,and the coincidence rate was 94.17%compared with the gold standard.The sensitivity,speci⁃ficity,positive predictive value and negative predictive value of single TCD foam test were 72.73%,75.96%,78.69%and 69.49%,respectively,while the sensitivity,specificity,positive predictive value and negative predictive value of sin⁃gle RCAC test were 71.21%,79.63%,81.03%and 69.35%,respectively.The sensitivity,specificity,positive predic⁃tive value and negative predictive value of the combination were 93.94%,94.44%,95.38%and 92.73%,respectively,which were higher than those of single application(P<0.05).Conclusion TCD foam test combined with RCAC can im⁃prove the accuracy of PFO diagnosis in young migraine patients.