摘要
目的分析经颅多普勒超声造影(cTCD)诊断缺血性脑卒中(IS)合并卵圆孔未闭(PFO)的价值。方法回顾性分析2021年6月至2023年12月于医院行cTCD、经食管超声心动图及右心声学造影检查的356例IS患者的临床资料,以经食管超声心动图+右心声学造影检查结果为金标准,分析cTCD对IS合并PFO的诊断价值,并比较cTCD诊断的静息状态PFO阳性患者[固有型右向左分流(RLS)]与Valsava动作下PFO阳性患者(潜在型RLS)的RLS分级和缺血部位等一般资料。结果356例IS患者经金标准确诊82例合并PFO,cTCD诊断85例PFO阳性(固有型RLS 42例,潜在型RLS 43例)。cTCD对IS合并PFO的诊断灵敏度为90.24%,特异度为95.99%,准确度为94.66%,与金标准的一致性Kappa系数为0.851(P<0.05)。固有型RLS患者的RLS分级及缺血灶多发占比高于潜在型RLS患者,而后循环缺血占比低于潜在型RLS患者,差异均有统计学意义(P<0.05)。结论cTCD对IS合并PFO的诊断价值较高,潜在型RLS患者的RLS分级更低,不同缺血灶及缺血部位的IS患者RLS类型不同。
Objective To analyze the value of contrast transcranial doppler(cTCD)in diagnosing ischemic stroke(IS)with patent foramen ovale(PFO).Methods With the retrospective analysis of clinical data from 356 patients with IS who underwent cTCD,transesophageal echocardiography,and right heart contrast echocardiography in hospitals from June 2021 to December 2023,using the results of transesophageal echocardiography and right heart contrast echocardiography as the gold standard,the diagnostic value of cTCD for IS with PFO was analyzed.In addition,general information such as RLS grading and ischemic site were compared between PFO positive patients diagnosed with cTCD in resting state[Inherent right to left shunt(RLS)]and PFO positive patients with Valsalva action(Potential RLS).Results Among the 356 IS patients,82 patients were diagnosed with PFO by the gold standard,and 85 patients were diagnosed with PFO by cTCD(42 patients with inherent RLS and 43 patients with potential RLS).The diagnostic sensitivity,specificity and accuracy of cTCD for IS combined with PFO were 90.24%,95.99%and 94.66%,and the Kappa coefficient of consistency with gold standard was 0.851(P<0.05).The RLS grade and the proportion of multiple ischemic foci in patients with inherent RLS were higher than those with potential RLS,and the proportion of posterior circulation ischemia was lower than those with potential RLS,with statistical significance(P<0.05).Conclusion The diagnostic value of cTCD for IS with PFO is high.Potential RLS patients have lower RLS grading,and the RLS types of IS patients with different ischemic foci and ischemic sites are different,which can provide reference for clinical treatment.
作者
苏丽芳
Su Lifang(The Affiliated Hospital of Putian University,Fujian Province,Putian Fujian 351100,China)
出处
《医疗装备》
2024年第13期20-23,共4页
Medical Equipment
