经颅多普勒超声发泡试验在卵圆孔未闭致隐源性脑卒中筛查中的应用价值

Application value of transcranial Doppler ultrasound foaming experiment in detection of cryptogenic stroke caused by patent foramen ovale

目的分析经颅多普勒超声(TCD)发泡试验在卵圆孔未闭(PFO)致隐源性脑卒中筛查中的应用价值。方法前瞻性研究。抽取2022年11月至2023年11月于南阳南石医院接受PFO筛查的116例隐源性脑卒中患者作为研究对象,所有患者均行TCD发泡试验与经食管超声心动图(TEE),以TEE结果作为"金标准",统计TCD对PFO致隐源性脑卒中的诊断结果与诊断效能,分析TCD在PFO致隐源性脑卒中筛查中的应用价值。结果116例隐源性脑卒中患者中,TEE检出阴性64例,阳性52例,其中卵圆孔形态为小型13例,中型22例,大型17例;TCD发泡试验显示Ⅰ级65例,Ⅱ级24例,Ⅲ级15例,Ⅳ级12例;TCD发泡试验检出阴性65例,阳性51例。TCD诊断PFO致隐源性脑卒中的结果与TEE诊断结果的一致性较强(Kappa=0.88,P<0.001);TCD诊断PFO致隐源性脑卒中的灵敏度、特异度、准确度、阳性预测值及阴性预测值均>90%,具有较高的诊断效能。结论TCD发泡试验在PFO中具有较高的诊断效能,可作为PFO致隐源性脑卒中筛查中首选的无创诊断方法。

Objective To analyze the application value of transcranial Doppler ultrasound(TCD)foaming experiment in detection of cryptogenic stroke caused by patent foramen ovale(PFO).Methods A total of 116 patients with cryptogenic stroke who underwent PFO screening in Nanshi Hospital of Nanyang from November 2022 to November 2023 were selected as the study subjects of the prospective study.All selected patients underwent TCD foaming experiment and transesophageal echocardiography(TEE)examinations.Taking the TEE results as the gold standard,the diagnostic results and diagnostic efficacy of TCD for cryptogenic stroke caused by PFO was analyzed;and the application value of TCD in screening for cryptogenic stroke caused by PFO was analyzed.Results Among the 116 patients with cryptogenic stroke,TEE detected out 64 cases negative and 52 cases positive.Among them,13 cases had small foramen ovale,22 cases had medium foramen ovale,and 17 cases had large foramen ovale.TCD foaming experiment identified 65 cases of grade I,24 cases of gradeⅡ,15 cases of gradeⅢ,and 12 cases of gradeⅣ.TCD foaming experiment confirmed 65 cases negative and 51 cases positive.The consistency between the results of TCD and TEE in the diagnosis of cryptogenic stroke caused by PFO was strong(Kappa=0.88,P<0.001).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of TCD in diagnosing cryptogenic stroke caused by PFO were all greater than 90%,indicating high diagnostic efficacy.Conclusions TCD foaming experiment has high diagnostic efficacy for PFO,and it can be the preferred non-invasive diagnostic method of screening for cryptogenic stroke caused by PFO.