经胸超声心动图与经胸右心声学造影诊断卵圆孔未闭所致偏头痛及右向左分流的比较  

Comparison of Transthoracic Echocardiography and Transthoracic Right Heart Contrast Echocardiography in the Diagnosis of Migraine and Right-to-Left Shunt Caused by Patent Foramen Ovale

作　　者：刘亚娟 许厚本 陈科兰 胡伯媛 李颖 LIU Ya-juan;XU Hou-ben;CHEN Ke-an;HU Bo-yuan;LI Ying(Department of Ultrasound Medicine,The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine(Hunan Province Directly Affiliated TCM Hospital),Zhuzhou,Hunan,412000,China)

机构地区：[1]湖南中医药高等专科学校附属第一医院(湖南省直中医医院)超声医学科,湖南株洲412000

出　　处：《现代生物医学进展》2024年第24期4743-4745,4752,共4页Progress in Modern Biomedicine

基　　金：湖南省卫生健康委科研课题(20210456)。

摘　　要：目的:探讨经胸超声心动图(TTE)与经胸右心声学造影(c-TTE)诊断卵圆孔未闭(PFO)所致偏头痛以及右向左分流(RLS)的价值。方法:选择82例疑似PFO所致的偏头痛患者,所有患者均接受TTE和c-TTE检查,以数字减影血管造影(DSA)结果为金标准,采用Kappa系数检验TTE、c-TTE与DSA检查结果的一致性,采用四格表法和受试者工作特征(ROC)曲线分析TTE、c-TTE诊断PFO所致偏头痛及RLS的效能。结果:82例偏头痛患者中,经DSA检查确诊60例PFO。TTE共检出42例PFO,与DSA诊断结果一致性一般(Kappa=0.294,P<0.05);c-TTE共检出57例PFO,与DSA诊断结果一致性很强(Kappa=0.879,P<0.05)。TTE共检出36例RLS,与DSA诊断结果一致性一般(Kappa=0.260,P<0.05);c-TTE共检出53例RLS,与DSA诊断结果一致性较强(Kappa=0.706,P<0.05)。与TTE相比,c-TTE诊断PFO的灵敏度、特异度、准确度、阳性预测值、阴性预测值均更高(Z=4.889,P<0.05)。与TTE相比,c-TTE诊断RLS的灵敏度、特异度、准确度、阳性预测值、阴性预测值均更高(Z=4.412,P<0.05)。结论:相对于TTE,c-TTE可更加灵敏、准确地诊断PFO及RLS分级,在PFO所致偏头痛患者中具有更高的诊断价值。Objective:To investigate the value of transthoracic echocardiography(TTE)and transthoracic right heart contrast echocardiography(c-TTE)in the diagnosis of migraine and right-to-left shunt(RLS)caused by patent foramen ovale(PFO).Methods:82patients with suspected PFO-induced migraine were selected,all patients underwent TTE and c-TTE examinations,the result of digital subtraction angiography(DSA)was used as the gold standard,the consistency of TTE,c-TTE and DSA results was tested by Kappa coefficient,the efficacy of TTE and c-TTE in the diagnosis of PFO-induced migraine and RLS was analyzed by four-grid table method and receiver operating characteristic(ROC)curve.Results:Among the 82 migraine patients,60 cases of PFO were diagnosed by DSA.TTE detected a total of 42 cases of PFO,which was generally consistent with the diagnostic results of DSA(Kappa=0.294,P<0.05).c-TTE detected a total of 57 cases of PFO,which was highly consistent with the results of DSA(Kappa=0.879,P<0.05).TTE detected a total of36 cases of RLS,which was generally consistent with the diagnostic results of DSA(Kappa=0.260,P<0.05).c-TTE detected a total of 53cases of RLS,which was consistent with the results of DSA(Kappa=0.706,P<0.05).Compared with TTE,c-TTE diagnosed PFO with higher sensitivity,specificity,accuracy,positive predictive value and negative predictive value(Z=4.889,P<0.05).Compared with TTE,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of c-TTE in diagnosing RLS were higher(Z=4.412,P<0.05).Conclusion:Relative to TTE,c-TTE can diagnose PFO and RLS classification more sensitively and accurately,and has higher diagnostic value in patients with migraine due to PFO.

关 键 词：偏头痛 卵圆孔未闭 右向左分流 经胸超声心动图 经胸右心声学造影 诊断效能 

分 类 号：R747.2[医药卫生—神经病学与精神病学]