不明原因中青年脑梗死RLS诊断cTCD和cTTE对比研究  

Comparative study of cTCD and cTTE in the diagnosis of RLS in young and middle aged cerebral infarction patients unexplained

作　　者：宋彬彬[1] 段智慧[1] 杜艳娇 王瑞琼 商丹丹 李丽 

机构地区：[1]洛阳市中心医院神经内科,河南洛阳471000 [2]河南省直第三人民医院,河南郑州450000

出　　处：《中国实用神经疾病杂志》2017年第24期25-31,共7页Chinese Journal of Practical Nervous Diseases

基　　金：河南省科技攻关计划(1503006A-1)

摘　　要：目的对比增强经颅多普勒(contrast-enhanced transcranial Doppler,cTCD)和经胸超声心动图声学造影(contrast enhanced transthroracic echocardiography,cTTE)对于不明原因中青年脑梗死患者右向左分流(right-to-left shunts,RLS)的诊断价值,探讨对于不明原因中青年脑梗死患者RLS的诊断方法。方法选取2015-01—2017-09洛阳市中心医院收治的不明原因中青年脑梗死患者166例,以激活生理盐水作为造影剂,选取肘前静脉注射,并结合Valsava动作,所有患者均同时进行cTCD和cTTE,诊断是否存在RLS,依据静息状态和Valsava动作是否存在分流分为固有型分流和潜在型分流,如果固有型分流Valsava动作后等级增高,则采用增高后的等级。结果166例患者中cTCD检测出RLS 80例(48.19%),cTTE检测出RLS 68例(40.96%),差异有统计学意义(P<0.005)。cTCD静息状态下检测出RLS 27例(16.27%),Valsalva动作后检测出RLS 80例(48.19%)。Valsalva动作后RLS检出率明显高于静息状态(P<0.005)。cTTE静息状态下检测出RLS 28例(16.87%),Valsalva动作后检测出RLS 68例(41.76%)。Valsalva动作后RLS检出率明显高于静息状态(P<0.005)。cTCD半定量分级结果:Ⅰ级少量分流26例(15.66%),Ⅱ级中量分流26例(15.66%),Ⅲ级大量分流28例(16.87%);cTTE半定量分级结果:Ⅰ级少量分流27例(16.27%),Ⅱ级中量分流19例(11.45%),Ⅲ级大量分流22例(13.25%)。两种检查方法的分级结果差异有统计学意义(Bowker检验值14.818,P=0.011),cTCD较cTTE检出RLS级别高。结论 cTCD和cTTE均可发现患者是否存在右向左分流,判断右向左分流的程度,但cTCD和cTTE相比阳性率更高,Valsalva动作后RLS检出率明显高于静息状态,半定量分级结果有差异,cTCD较cTTE检出RLS级别高。cTCD更适合作为RLS的初筛手段。Objective To investigate the diagnosis value of cTCD（contrast-enhanced transcranial Doppler） and cTTE（con-trast-enhanced transthoracic echocardiography ） for RLS（right-to-left shunts） in young and middle aged cerebral infarction patients unexplained .Methods A total of 166 young and middle aged cerebral infarction patients unexplained in our hospital from January 2015 to September 2017 were collected .By taking the physiological saline activating via elbow intravenous injection as a contrast a-gent ,and combined with Valsalva maneuver ,all patients were simultaneously performed the cTCD and cTTE examination to diag-nose whether the RLS existed .RLS was divided into the inherent and potential shunt based on whether there was a shunt at resting state or after Valsalva maneuver .If the grade of the inherent shunt after Valsalva maneuver reached to a higher level ,the higher level would be adopted .Results The RLS was detected by cTCD in the 80 （48 .19% ） of 166 patients and by cTTE in the 68 （40.96% ） of 166 patients .The difference was statistically significant （P〈 0.005） .The RLS was detected by cTCD in the 27 （16.27% ） of 166 patients at resting state and in the 80 （48 .19% ） of 166 patients after Valsalva maneuver .The detection rate of RLS after Valsalva maneuver was significantly higher than that at resting state （P〈0.005） .The RLS was detected by cTTE in the 28 （16.87% ） of 166 patients at resting state and in the 68 （41.76% ） of 166 patients after Valsalva maneuver .The detection rate of RLS after Valsalva maneuver was significantly higher than that at resting state （P〈0.005） .The results of the semi-quan-titative classification of cTCD showed that 26（15.66% ） cases in the small shunt of level one ,26（15.66% ） cases in the medium shunt of level two and 28 （16.87% ） cases in the large shunt of level three .The results of the semi-quantitative classification of cTTE showed that 27（16.27% ） cases in the small shunt of level one ,19（16.87% �

关 键 词：增强TCD TTE声学造影 右向左分流 隐源性卒中 卵圆孔未闭 

分 类 号：R743.33[医药卫生—神经病学与精神病学]