经胸超声心动图结合右心声学造影在评估隐源性脑卒中患者卵圆孔未闭右向左分流的临床价值  

Clinical value of transthoracic echocardiography combined with right heart contrast-enhanced transthoracic echocardiography in evaluating patent foramen ovale related right to left shunt in patients with cryptogenic stroke

作　　者：刘江燕 柳建荟 薛鹏 郭华 LIU Jiang-yan;LIU Jian-hui;XUE Peng(Department of Cardio-vascular Ultrasonography Room,Linfen Central Hospital,Linfen Shanxi 041000,China)

机构地区：[1]临汾市中心医院心脏血管超声室,山西临汾041000

出　　处：《临床和实验医学杂志》2025年第6期667-670,共4页Journal of Clinical and Experimental Medicine

基　　金：临汾市科技重点研发计划(编号:2332)。

摘　　要：目的探究经胸超声心动图(TTE)结合右心声学造影(c-TTE)在评估隐源性脑卒中(CS)患者卵圆孔未闭(PFO)右向左分流(RLS)的临床价值。方法选取自2020年1月至2024年4月临汾市中心医院收治的60例CS患者为研究对象,均接受TTE、c-TTE和经食管超声心动图(TEE),分析其在评估CS患者PFO-RLS中的价值。结果c-TTE检测的静息状态下阳性率、Valsalva动作下阳性率分别为48.33%、60.00%,均显著高于TTE检测(30.00%、40.00%),差异均有统计学意义(P<0.05)。以TEE检查为金标准,60例CS患者中35例PFO-RLS阳性,25例阴性。TTE检查、c-TTE检查阳性分别有24、36例,阴性分别有36、24例。c-TTE的检查敏感度、特异度、准确度、阳性预测值、阴性预测值分别为100.00%、96.00%、98.33%、97.22%、100.00%,均显著高于TTE的51.42%、76.00%、61.67%、75.00%、52.78%,差异均有统计学意义(P<0.05)。TTE、c-TTE检查PFO-RLS 0级、Ⅰ级、Ⅱ级、Ⅲ级的分布情况差异有统计学意义(P<0.05)。与TTE检查相比,c-TTE检查对PFO-RLS 0级、Ⅰ级的检出率降低,但差异无统计学意义(P>0.05),对PFO-RLSⅡ级、Ⅲ级的检出率更高,差异均有统计学意义(P<0.05)。结论c-TTE能提高CS患者静息状态下、Valsalva动作下PFO-RLS阳性检出率,提高PFO-RLS阳性诊断效能和PFO-RLSⅡ级、Ⅲ级的检出率。Objective To explore the clinical value of transthoracic echocardiography(TTE)combined with right heart contrast-enhanced transthoracic echocardiography(c-TTE)in evaluating patent foramen ovale(PFO)related right to left shunt(RLS)in patients with cryptogenic stroke(CS).Methods Sixty patients with CS admitted to the hospital from January 2020 to April 2024 were selected as the study subjects.All of them underwent TTE,c-TTE and transesophageal echocardiography(TEE).The value of these methods in evaluating PFO-RLS in patients with CS was analyzed.Results The positive detection rates of c-TTE in resting and Valsalva were 48.33%,60.00%,which were significantly higher than those of TTE(30.00%,40.00%),the differences were statistically significant(P<0.05).TEE found that 35 out of 60 patients with CS were positive for PFO-RLS and 25 were negative.TTE and c-TTE were positive in 24 and 36 cases,respectively,and negative in 36 and 24 cases,respectively.The sensitivity,specificity,accuracy,positive and negative predictive values of c-TTE were 100.00%,96.00%,98.33%,97.22% and 100.00%,which were significantly higher than those of TTE(51.42%,76.00%,61.67%,75.00% and 52.78%),the differences were statistically significant(P<0.05).The distribution of grade 0,grade Ⅰ,grade Ⅱ and grade Ⅲ PFO-RLS displayed by TTE and c-TTE showed statistically significant differences(P<0.05).Compared with TTE,the detection rates of grade 0 and grade Ⅰ PFO-RLS using c-TTE were lower,but the differences were not significant(P>0.05).The detection rates of grade Ⅱ and grade Ⅲ PFO-RLS were higher,the differences were statistically significant(P<0.05).Conclusion c-TTE can improve the positive detection rate of PFO-RLS in patients with CS in resting and Valsalva,enhance the diagnostic efficacy for PFO-RLS and increase the detection rates of grade Ⅱ and grade Ⅲ PFO-RLS.

关 键 词：隐源性脑卒中 卵圆孔未闭 右向左分流 经胸超声心动图 右心声学造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]