c-TCD与c-TTE联合检测对卵圆孔未闭致隐源性卒中患者的诊断效能

Diagnostic efficacy of c-TCD combined with c-TTE in patients with patent foramen ovale-induced cryptogenic stroke

目的探讨经颅多普勒超声发泡试验(c-TCD)与右心声学造影(c-TTE)联合检测对卵圆孔未闭(PFO)致隐源性卒中(CS)患者的诊断效能,并分析两者联合检测与TEE诊断右向左分流(RLS)半定量分级结果的一致性。方法回顾性选取2021年12月至2023年12月河南省濮阳市安阳地区医院收治的疑似PFO致CS患者108例,均进行食管超声心动图(TEE)、c-TCD及c-TTE检查。以TEE检查结果为“金标准”,分析c-TCD、c-TTE单独及联合检测结果,分析c-TCD、c-TTE单独及联合检测对PFO致CS的诊断效能;采用Kappa指数分析c-TCD、c-TTE联合检测与TEE诊断RLS半定量分级结果的一致性。结果TEE检查结果显示,108例患者中PFO致CS阳性65例,阴性43例。以TEE检查结果为金标准,c-TCD检测诊断PFO致CS真阳性50例,假阳性3例,假阴性15例,真阴性40例,诊断灵敏度为76.92%(50/65)、特异度为93.02%(40/43)、准确度为83.33%(90/108);c-TTE检测诊断PFO致CS真阳性48例,假阳性2例,假阴性17例,真阴性41例,诊断灵敏度为73.85%(48/65)、特异度为95.35%(41/43)、准确度为82.41%(89/108);c-TCD与c-TTE联合检测诊断PFO致CS真阳性61例,假阳性4例,假阴性4例,真阴性39例,诊断灵敏度为93.85%(61/65)、特异度为90.70%(39/43)、准确度为92.59%(100/108);c-TCD与c-TTE联合检测诊断PFO致CS的灵敏度、阴性预测值均高于c-TCD、c-TTE单独诊断,漏诊率低于c-TCD、c-TTE单独诊断,差异均有统计学意义(P<0.05);c-TCD与c-TTE联合检测分级结果与TEE诊断RLS半定量分级结果一致性检验Kappa值为0.882(95%CI:0.768~0.997),高于c-TCD[0.730(95%CI:0.615~0.845)]、c-TTE[0.728(95%CI:0.613~0.842)]单独诊断,差异均有统计学意义(P<0.05)。结论c-TCD与c-TTE联合联测对PFO致CS具有较高诊断价值,且可有效评估RLS半定量分级,可作为临床诊断PFO致CS、评估病情分级的有效检查方案,并对后续临床治疗具有一定指导价值。

Objective To explore the diagnostic efficacy of transcranial Doppler ultrasound bubble test(c-TCD)combined with transthoracic echocardiography contrast acoustics(c-TTE)in patients with patent foramen ovale(PFO)-induced cryptogenic stroke(CS),and to analyze the consistency of the semi-quantitative grading re-sults between the combined detection and transesophogeal echocardiography(TEE)for diagnosing right-to-left shunt(RLS).Methods A total of 108 suspected PFO-induced CS patients were retrospectively selected from Anyang District Hospital from Dec.2021 to Dec.2023.Transesophogeal echocardiography(TEE),c-TCD,and c-TTE were per-formed.Taking TEE test results as the"gold standard",the results of c-TCD and c-TTE alone and in combination were analyzed,and the diagnostic efficacy of c-TCD,c-TTE alone and in combination on PFO-induced CS was analyzed.Kap-pa index was used to analyze the consistency of the results of c-TCD and c-TTE in combination with TEE for diagnosing RLS semi-quantitative classification.Results TEE examination results showed that among the 108 patients,PFO-in-duced CS was positive in 65 cases and negative in 43 cases.Taking TEE test results as the gold standard,c-TCD results for diagnosing PFO-induced CS showed 50 true positive cases,3 false positive cases,15 false negative cases,and 40 true negative cases,with the diagnostic sensitivity of 76.92%(50/65),specificity of 93.02%(40/43),and accuracy of 83.33%(90/108).c-TTE results showed 48 true positive cases,2 false positive cases,17 false negative cases,and 41 true nega-tive cases,with the diagnostic sensitivity of 73.85%(48/65),specificity of 95.35%(41/43),and accuracy of 82.41%(89/108).The combined detection of c-TCD and c-TTE for diagnosing PFO-induced CS showed 61 true positive cases,4 false positive cases,4 false negative cases,and 39 true negative cases,with the diagnostic sensitivity of 93.85%(61/65),specificity of 90.70%(39/43),and accuracy of 92.59%(100/108).The sensitivity and negative predictive value of c-TCD combined with c-TTE in the diagnosis of PFO-induced CS were significantly higher than those of c-TCD and c-TTE alone,and the missed diagnosis rate was significantly lower than that of c-TCD and c-TTE detection alone,with statistically significant differences(P<0.05).The Kappa value of combined detection of c-TCD and c-TTE with TEE for diagnosing RLS semi-quantitative classification was 0.882(95%CI:0.768-0.997),which was significantly higher than 0.730(95%CI:0.615-0.845)of c-TCD and[0.728(95%CI:0.613-0.842)of c-TTE alone,and the differences were sta-tistically significant(P<0.05)].Conclusion c-TCD and c-TTE combined detection has high diagnostic value for PFO-in-duced CS,and can effectively evaluate the semi-quantitative classification of RLS,which can be used as an effective ex-amination scheme for the clinical diagnosis of PFO-induced CS and evaluation of disease grading and has certain guid-ing value for subsequent clinical treatment.