cTTE对卵圆孔未闭的诊断分析及联合NLR预测隐源性卒中的价值  

Diagnostic analysis of cTTE for patent foramen ovale and the value of combined NLR monitoring in predicting cryptogenic stroke

作　　者：王聪[1] 范东晨[1] 王曼 张忠路[1] Wang Cong;Fan Dongchen;Wang Man;Zhang Zhonglu(Department of Ultrasound,Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Medical imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院超声科,济宁272029 [2]济宁医学院附属医院医学影像科,济宁272029

出　　处：《中国医师杂志》2023年第1期66-70,共5页Journal of Chinese Physician

基　　金：济宁市重点研发计划项目(2019SMNS004)。

摘　　要：目的探讨经胸超声心动图声学造影(cTTE)在卵圆孔未闭中的诊断价值以及联合中性粒细胞与淋巴细胞比值(NLR)预测隐源性卒中的价值。方法选取2021年1月至2021年12月在济宁医学院附属医院就诊的疑似卵圆孔未闭患者120例,予以cTTE和经食管超声心动图(TEE)检查,分析cTTE诊断卵圆孔未闭的价值,同时对比分析卵圆孔未闭合并和未合并隐源性卒中患者的临床资料、cTTE参数差异。结果共确诊卵圆孔未闭患者69例,69例患者中经MRI确诊合并隐源性卒中患者23例,未合并隐源性卒中患者46例。cTTE诊断卵圆孔未闭价值较高,其中Valsalva动作行cTTE,其诊断卵圆孔未闭的灵敏度、准确度和阴性预测值分别为95.65%、91.67%和93.62%,明显高于cTTE静息状态(均P<0.05)。卵圆孔未闭合并隐源性卒中患者NLR、卵圆孔未闭-右向左分流(PFO-RLS)大量分流比例、卵圆孔未闭(PFO)入口宽度、PFO出口宽度分别为(3.01±0.89)、43.48%(10/23)、(2.54±0.65)mm和(1.51±0.35)mm,明显高于未合并隐源性卒中患者(均P<0.05)。Logistic回归分析结果显示:NLR和PFO-RLS分流程度是卵圆孔未闭患者合并隐源性卒中的影响因素(均P<0.05)。NLR联合PFO-RLS分流程度预测卵圆孔未闭合并隐源性卒中的ROC曲线下面积为0.905,明显高于NLR、PFO-RLS分流程度单独预测(均P<0.05)。结论cTTE对卵圆孔未闭有较好的诊断价值,cTTE联合NLR在预测卵圆孔未闭合并隐源性卒中有一定的应用价值。Objective To investigate the diagnostic value of transthoracic echocardiographic contrast-enhanced ultrasound(cTTE)in patent foramen ovale(PFO)and the value of combined neutrophil to lymphocyte ratio(NLR)in predicting cryptogenic stroke.Methods A total of 120 suspected PFO patients admitted to the Affiliated Hospital of Jining Medical College from January 2021 to December 2021 were selected and examined by cTTE and transesophageal echocardiography(TEE)to analyze the diagnostic value of cTTE in PFO.The clinical data and cTTE parameters of PFO patients with and without cryptogenic stroke were analyzed.Results A total of 69 patients with PFO were confirmed.Among the 69 patients,23 patients with cryptogenic stroke and 46 patients without cryptogenic stroke were confirmed by magnetic resonance imaging(MRI).The value of cTTE in the diagnosis of PFO was high:the sensitivity,accuracy and negative predictive value of cTTE under Valsalva motion in the diagnosis of PFO were 95.65%,91.67%and 93.62%,respectively,which were significantly higher than that of cTTE at rest(all P<0.05).The NLR,the proportion of large shunt of PFO right to left shunt(PFO-RLS),the inlet width of patent foramen ovale(PFO)and the outlet width of PFO in patients with PFO complicated with cryptogenic stroke were(3.01±0.89),43.48%(10/23),(2.54±0.65)mm and(1.51±0.35)mm,respectively,which were significantly higher than those in patients without cryptogenic stroke(all P<0.05).Logistic regression analysis showed that NLR and the degree of PFO-RLS shunt were the influencing factors of patients with PFO complicated with cryptogenic stroke(both P<0.05).The area under the Receiver operating characteristic(ROC)curve predicted by NLR combined with PFO-RLS shunt was 0.905,which was significantly higher than that predicted by NLR and PFO-RLS shunt alone(all P<0.05).Conclusions cTTE has a good value in the diagnosis of PFO,and cTTE combined with NLR has a certain application value in predicting PFO complicated with cryptogenic stroke.

关 键 词：卵圆孔 未闭 超声心动描记术 中性粒细胞 淋巴细胞 隐源性卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]