声学造影在青年短暂性脑缺血发作患者合并卵圆孔未闭右向左分流的诊断价值  

Diagnostic value of acoustic angiography in young patients with right-to-left shunt of patent foramen ovale and transient ischemic attack

作　　者：董强利 卜豪英 蔡丹灵[1] 陈屏[1] 任丹凤 祝小辉 段晓晓[2] DONG Qiang-li;BU Hao-ying;CAI Dan-ling;CHEN Ping;REN Dan-feng;ZHU Xiao-hui;DUAN Xiao-xiao(Yellow River Central Hospital,Zhengzhou 450003,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]黄河中心医院,河南郑州450003 [2]河南省人民医院超声科,河南郑州450003

出　　处：《中国临床医学影像杂志》2025年第1期34-37,共4页Journal of China Clinic Medical Imaging

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220703)。

摘　　要：目的:探讨经颅多普勒发泡实验(cTCD)、经胸超声心动图右心声学造影(cTTE)、经食管超声心动图右心声学造影(cTEE)在青年短暂性脑缺血发作(TIA)患者中合并卵圆孔未闭(PFO)右向左分流的诊断价值。方法:回顾性分析2021年10月—2023年10月经我院神经内科确诊为TIA的青年患者100例,男60例,女40例,年龄18~45岁,平均(32.6±2.3)岁。选同期进行健康体检年龄、性别相匹配的100例志愿者作为对照组。所有受试者均可以有效完成cTCD、cTTE、cTEE检查。结果:(1)三种检查方法在Valsalva状态下PFO右向左分流筛出率均高于静息状态,差异具有统计学意义,P<0.05;(2)TIA组与对照组分别配合Valsalva动作PFO阳性率比较,差异具有统计学意义,P<0.05;(3)以cTEE为诊断PFO右向左分流的“金标准”,cTCD诊断PFO右向左分流的AUC:0.595,敏感度100%、特异度95.83%,误诊5例;cTTE诊断PFO右向左分流的AUC:0.585,敏感度93.75%、特异度98.33%,误诊2例,P<0.05;(4)三种检查方法对PFO半定量结果比较,差异无统计学意义,P>0.05。cTCD、cTTE诊断PFO分级与cTEE测量的左、右心房侧卵圆孔开口处内径呈正向强相关性,与隧道长度无相关性。结论:三种声学造影配合Valsalva动作可有效提高PFO的检出率,TIA患者相对健康人有较高的PFO患病率,cTCD可作为PFO的初筛工具,cTTE对诊断PFO右向左分流的分级具有一定的优势,cTEE作为PFO的“金标准”,有效排除肺内型右向左分流。因此利用三种声学造影配合Valsalva动作可提高TIA患者PFO的诊断价值。Objective:To explore the diagnostic value of contrast enhanced transcranial Doppler(cTCD),contrast transthoracic echocardiography(cTTE),contrast transesophageal echocardiography(cTEE)in right-to-left shunt of patent foramen ovale(PFO)in young patients with transient ischemic attack(TIA).Methods:A retrospective analysis was performed on 100 young patients diagnosed with TIA in the department of neurology of our hospital from October 2021 to October 2023,including 60males and 40 females,aged 18~45 years,with an average age of(32.6±2.3)years.Volunteers matching age and gender were selected as the control group.All subjects were able to effectively complete cTCD,cTTE and cTEE examination.Results:(1)The screening rate of right-to-left shunt of PFO in Valsalva state was higher than that in resting state,the difference was statistically significant(P<0.05);(2)The positive rate of PFO combined with Valsalva maneuver in TIA group and control group was compared,and the difference was statistically significant(P<0.05);(3)Using cTEE as the“gold standard”for the diagnosis of right-to-left shunt of PFO,c TCD diagnosed the right-to-left shunt of PFO with an AUC of 0.595,sensitivity of 100%,specificity of 95.83%,misdiagnosis 5 cases.cTTE diagnosed the right-to-left shunt of PFO with an AUC of 0.585,sensitivity of 93.75%,specificity of 98.33%.Two cases were misdiagnosed(P<0.05);(4)There was no significant difference in the semiquantitative results of PFO among the three methods(P>0.05).The grading of PFO diagnosed by cTCD and cTTE was positively correlated with the inner diameter of the left and right atrial foramen ovale opening measured by cTEE,but not with the tunnel length.Conclusion:Three kinds of acoustic angiography combined with Valsalva maneuver can effectively improve the detection rate of PFO,compared with healthy people,TIA patients have a higher prevalence of PFO,cTCD can be used as a preliminary screening tool for PFO,c TTE has certain advantages in the grading of right-to-left shunt of PFO,cTEE serves as the�

关 键 词：脑缺血发作 短暂性 卵圆孔 未闭 超声心动描记术 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R541.1[医药卫生—临床医学] R540.45