发泡试验联合经食道超声对隐源性脑卒中的诊断价值  

Diagnostic value of contrast-enhanced transcranial Doppler combined with transesophageal echocardiography on cryptogenic stroke

作　　者：王艳[1] 卢学峰[1] 邱敬涛[1] 李楠[1] 甄艳华[1] 冉青[1] WANG Yan;LU Xuefeng;QIU Jingtao;LI Nan;ZHEN Yanhua;RAN Qing(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2022年第12期1490-1494,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省科技厅科技攻关项目(编号:182102311215)。

摘　　要：目的探究经颅多普勒超声发泡试验(cTCD)联合经食道超声心动图(TEE)对隐源性脑卒中(CS)的诊断价值。方法回顾性分析郑州大学第二附属医院108例经TOAST分型判断为CS患者的临床资料,分析cTCD、TEE对CS患者卵圆孔未闭(PFO)的诊断价值;将c TCD联合TEE检查阳性者纳入阳性组,cTCD联合TEE检查均为阴性者纳入阴性组,比较2组性别、年龄、基础疾病等一般临床特征及梗死灶数目、梗死部位等影像学特征差异,并使用Logistic回归分析评估CS患者发生PFO的危险因素。结果108例CS患者经c TCD检出PFO阳性64例,其中Ⅰ级38例,Ⅱ级18例,Ⅲ级8例;TEE检出PFO阳性53例,cTCD与TEE诊断CS患者发生PFO的Kappa系数为0.723,一致性较好;cTCD、TEE检查均为阳性者51例,纳入阳性组;均为阴性者42例,纳入阴性组;2组性别、年龄、吸烟史、饮酒史及高血压、糖尿病等情况比较,差异无统计学意义(P>0.05);阳性组梗死灶数目及后循环梗死率明显高于阴性组(P<0.05)。经Logistic回归分析,发现梗死灶多发、后循环梗死是CS患者发生PFO的独立危险因素(OR=2.440、3.327,P<0.05)。结论cTCD联合TEE对诊断CS患者PFO有重要作用。Objective To explore the diagnostic value of contrast-enhanced transcranial Doppler(cTCD) combined with transesophageal echocardiography(TEE)on cryptogenic stroke(CS).Methods The clinical data of 108 patients who were judged with CS by TOAST classification in our hospital were retrospectively analyzed,and the diagnostic value of cTCD and TEE on patent foramen ovale(PFO)in patients with CS was analyzed.The patients with positive cTCD combined with TEE were included in positive group,and the patients with negative cTCD combined with TEE were included in negative group.The differences in general clinical characteristics of gender,age and underlying disease and imaging characteristics of the number of infarcts and infarct location were compared between the two groups.Logistic regression analysis was used to assess the risk factor of PFO in patients with CS.Results Among 108 cases of patients with CS,64 cases were with positive PFO by c TCD,including 38 cases of grade I,18 cases of grade II and 8 cases of grade III.53 cases were with positive PFO detected by TEE.The Kappa coefficient of cTCD and TEE was 0.723 in the diagnosis of PFO in patients with CS,with good consistency.51 cases who were positive for cTCD examination and TEE examination were included in positive group,and 42 cases who were negative were included in negative group.There were no statistically significant differences in terms of gender,age,smoking history,drinking history,hypertension and diabetes mellitus between the two groups(P>0.05).The number of infarcts and posterior circulation infarct rate in positive group were significantly higher than those in negative group(P<0.05).Logistic regression analysis showed that multiple infarcts and posterior circulation infarct were independent risk factors for PFO in patients with CS(OR=2.440,3.327,P<0.05).Conclusion c TCD combined with TEE has an important role in the diagnosis of PFO in patients with CS.

关 键 词：隐源性脑卒中 cTCD TEE 卵圆孔未闭 梗死部位 

分 类 号：R614743.3[医药卫生—麻醉学]