发泡实验及经食道超声在卵圆孔未闭中的诊断价值(1)
【摘要】 目的：探讨经颅多普勒发泡实验(c-TCD)联合经胸发泡实验及经食道超声在不明原因缺血性脑卒中患者卵圆孔未闭(PFO)筛查中的应用价值。方法：选择2017年1-12月在本院神经内科就诊的隐源性脑卒中(CS)患者60例，行头颅CT或MRI检查诊断缺血性脑卒中，并行常规实验室检查、经胸超声心动图(TTE)、颈动脉彩超、下肢静脉彩超、24 h动态心电图排除其他明确高危因素。所有患者行經颅多普勒发泡实验(c-TCD)联合经胸发泡实验(即经胸右心声学造影)及经食道超声心动图(TEE)检测，评价两种方法的诊断价值。结果：60例患者中经TEE检出率为53.3%(32/60)，发泡实验平静呼吸时检出率为58.3%(35/60)，两者比较差异无统计学意义(P>0.05);发泡实验行Valsalva动作后检出率为71.6%(43/60)，与TEE相比较差异有统计学意义(P<0.05)。结论：经颅多普勒发泡实验联合经胸发泡实验对缺血性脑卒中患者卵圆孔未闭的检出有较高的敏感性，行Valsalva动作后可提高敏感性，可作为诊断PFO的首选非侵入性方法。
【关键词】 经食道超声心动图; 发泡实验; 隐源性缺血性脑卒中; 卵圆孔未闭
【Abstract】 Objective：To expore the value of transcranial Doppler ultrasound foaming test (c-TCD) joint transthoracic ultrasound foaming test and transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) in patients with cryptogenic ischemic stroke(CS).Method：A total of 60 patients with cryptogenic ischemic stroke (CS) treated in neurology department of our hospital from January to December 2017 were selected for study.All patients were diagnosed as ischemic stroke with CT and MRI.Regular laboratory examination，transthoracic echocardiography(TTE)，carotid artery ultrasonograph，leg vein ultrasonography and 24 hours dynamic electrocardiogram were performed to eliminate other clear risk factors.All stroke patients underwent c-TCD joint transthoracic ultrasound foaming test (right heart contrast echocardiography) and TEE，evaluated the diagnostic value of two methods.Result：In 60 cases of CS，the detection rate of TEE was 53.3%(32/60)，and the detection rate of ultrasound foaming test in normal respiration was 58.3%(35/60).There was no significant difference between the two methods(P>0.05).The detection rate of ultrasound foaming test in Valsalva was 71.6%(43/60)，the difference was statistically significant(P<0.05).Conclusion：c-TCD joint transthoracic ultrasound foaming test is an excellent method for PFO identification with high sensibility while under Valsalva.It can be used as the preferred non-invasive method for suspected PFO in patients with CS before TEE.
【Key words】 Transthoracic echocardiography; Ultrasound foaming test; Cryptogenic ischemic stroke;Patent foramen ovale
First-author’s address：The First Hospital of Nanchang City，Nanchang 330008，China
doi：10.3969/j.issn.1674-4985.2019.01.039
缺血性脑卒中在我国的发病率呈逐年上升趋势，并且具有较高的致残率，已成为威胁人类健康的主要疾病之一。除因大动脉粥样硬化、心源性栓塞、小动脉闭塞等引起的脑卒中以外，未发现常见致病因素者称为隐源性缺血性脑卒中(cryptogenic ischemic stroke，CS)。目前认为有40%以上的缺血性卒中为CS[1]，尽管进行了完善的检查，病因依然不完全明确，不能进行针对性的二级预防[2]，其病因主要包括：卵圆孔未闭合并静脉栓子、阵发性心房颤动、感染、中毒、血管痉挛等[3]。其中，卵圆孔未闭(patent foramen ovale，PFO)可作为来自静脉循环“反常性栓子”的通道导致脑梗死，是导致CS的一个重要病因[4]。传统检出PFO方法主要是经胸超声心动图，但由于受检查者自身水平以及患者声窗条件等客观因素导致PFO检出率并不高，随着经食道超声心动图(transesophageal echocardiography，TEE)的广泛应用，PFO的检出率大大提高，是目前PFO诊断的金标准[5-6]。但是，TEE为侵入性操作，患者痛苦较大，并且有检查的相对和绝对禁忌证，限制了其应用。近年来多项研究结果表明，c-TCD可作为PFO的无创筛查手段。本研究探讨c-TCD联合经胸发泡实验及TEE对CS患者PFO的诊断价值，现报道如下。, 百拇医药(刘婷婷 宋嫣)
【关键词】 经食道超声心动图; 发泡实验; 隐源性缺血性脑卒中; 卵圆孔未闭
【Abstract】 Objective：To expore the value of transcranial Doppler ultrasound foaming test (c-TCD) joint transthoracic ultrasound foaming test and transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) in patients with cryptogenic ischemic stroke(CS).Method：A total of 60 patients with cryptogenic ischemic stroke (CS) treated in neurology department of our hospital from January to December 2017 were selected for study.All patients were diagnosed as ischemic stroke with CT and MRI.Regular laboratory examination，transthoracic echocardiography(TTE)，carotid artery ultrasonograph，leg vein ultrasonography and 24 hours dynamic electrocardiogram were performed to eliminate other clear risk factors.All stroke patients underwent c-TCD joint transthoracic ultrasound foaming test (right heart contrast echocardiography) and TEE，evaluated the diagnostic value of two methods.Result：In 60 cases of CS，the detection rate of TEE was 53.3%(32/60)，and the detection rate of ultrasound foaming test in normal respiration was 58.3%(35/60).There was no significant difference between the two methods(P>0.05).The detection rate of ultrasound foaming test in Valsalva was 71.6%(43/60)，the difference was statistically significant(P<0.05).Conclusion：c-TCD joint transthoracic ultrasound foaming test is an excellent method for PFO identification with high sensibility while under Valsalva.It can be used as the preferred non-invasive method for suspected PFO in patients with CS before TEE.
【Key words】 Transthoracic echocardiography; Ultrasound foaming test; Cryptogenic ischemic stroke;Patent foramen ovale
First-author’s address：The First Hospital of Nanchang City，Nanchang 330008，China
doi：10.3969/j.issn.1674-4985.2019.01.039
缺血性脑卒中在我国的发病率呈逐年上升趋势，并且具有较高的致残率，已成为威胁人类健康的主要疾病之一。除因大动脉粥样硬化、心源性栓塞、小动脉闭塞等引起的脑卒中以外，未发现常见致病因素者称为隐源性缺血性脑卒中(cryptogenic ischemic stroke，CS)。目前认为有40%以上的缺血性卒中为CS[1]，尽管进行了完善的检查，病因依然不完全明确，不能进行针对性的二级预防[2]，其病因主要包括：卵圆孔未闭合并静脉栓子、阵发性心房颤动、感染、中毒、血管痉挛等[3]。其中，卵圆孔未闭(patent foramen ovale，PFO)可作为来自静脉循环“反常性栓子”的通道导致脑梗死，是导致CS的一个重要病因[4]。传统检出PFO方法主要是经胸超声心动图，但由于受检查者自身水平以及患者声窗条件等客观因素导致PFO检出率并不高，随着经食道超声心动图(transesophageal echocardiography，TEE)的广泛应用，PFO的检出率大大提高，是目前PFO诊断的金标准[5-6]。但是，TEE为侵入性操作，患者痛苦较大，并且有检查的相对和绝对禁忌证，限制了其应用。近年来多项研究结果表明，c-TCD可作为PFO的无创筛查手段。本研究探讨c-TCD联合经胸发泡实验及TEE对CS患者PFO的诊断价值，现报道如下。, 百拇医药(刘婷婷 宋嫣)