右心声学造影联合经颅多普勒发泡实验在卵圆孔未闭诊断中的应用价值

Application value of right heart acoustics combined with transcranial Doppler ultrasound foaming test in the diagnosis of patent foramen ovale

目的:探讨经胸右心声学造影(cTTE)联合经颅多普勒发泡实验(cTCD)在诊断卵圆孔未闭(PFO)中的应用价值。方法:选取隐源性脑卒中、短暂性脑缺血发作或顽固性偏头痛病人110例,均行cTTE联合cTCD检查,以经食管超声作为诊断PFO的“金标准”,均排除PFO以外的其他结构性心脏病。分析单一种方法和联合诊断PFO的诊断率及差异性。结果:110例病人中有88例存在PFO,发病率为80%。静息状态下,cTTE诊断PFO 57例,诊断率70.00%,灵敏度63.64%,特异度95.45%;cTCD诊断PFO 62例,诊断率72.73%,灵敏度68.18%,特异度90.91%,2种方法比较差异无统计学意义(P>0.05);Valsalva动作下,cTTE诊断PFO 61例,诊断率71.82%,灵敏度67.05%,特异度90.91%;cTCD诊断PFO73例,诊断率82.73%,灵敏度80.68%,特异度90.91%。cTTE诊断PFO低于cTCD,两者差异有统计学意义(P<0.05);两者联合诊断PFO 83例,诊断率91.82%,灵敏度92.05%,特异度90.91%,两者联合诊断PFO明显高于单一种方法诊断,差异有统计学意义(P<0.05)。结论:cTTE联合cTCD诊断诊断PFO具有更高的检出率,操作简便,病人无痛苦,易于接受,值得临床推广。

Objective:To explore the application value of contrast transthoracic echocardiography(cTTE)and contrast-enhanced transcranial Doppler(cTCD)in the diagnosis of patent foramen ovale(PFO).Methods:A total of 110 patients with cryptogenic stroke,transient ischemic attack,or intractable migraine were selected.All enrolled patients were examined with cTTE and cTCD.TEE was used as the"gold standard"for diagnosing PFO.All patients excluded other structural heart diseases except PFO.The diagnostic rates and differences between a single method and a combination for diagnosing PFO were analyzed.Results:PFO was present in 88 of 110 patients with a prevalence of 80%.At rest state,cTTE diagnosed 57 cases of PFO,with a diagnostic rate of 70.00%,sensitivity of 63.64%,and specificity of 95.45%;62 cases of PFO were diagnosed with cTCD,with a diagnostic rate of 72.73%,sensitivity of 68.18%,and specificity of 90.91%.There was no statistically significant difference between the two methods(P>0.05);under valsalva action,cTTE diagnosed 61 cases of PFO,with a diagnostic rate of 71.82%,sensitivity of 67.05%,and specificity of 90.91%;73 cases of PFO were diagnosed with cTCD,with a diagnostic rate of 82.73%,sensitivity of 80.68%,and specificity of 90.91%.The diagnostic PFO of cTTE was lower than that of cTCD,and the difference between the two is statistically significant(P<0.05);83 cases of PFO were diagnosed by combining the two methods,with a diagnostic rate of 91.82%,sensitivity of 92.05%,and specificity of 90.91%.The combination of the two methods for diagnosing PFO was significantly higher than that of a single method,and the difference was statistically significant(P<0.05).Conclusions:The combination of cTTE and cTCD for diagnosing PFO has a higher detection rate,easy operation,no pain,and accessible patient acceptance,which is worthy of clinical promotion.