偏头痛和隐源性脑卒中患者经食管超声心动图右心声学造影特征分析

目的：分析偏头痛和隐源性脑卒中患者经食管超声心动图右心声学造影(c-TEE)特征,探讨 c-TEE在不同疾病右向左分流类型评估中的作用。方法：选取2018年1月至2018年10月我院收治的疑诊右向左分流相关的偏头痛患者146例,隐源性脑卒中患者167例作为研究对象进行回顾性分析。所有入选患者均完成TEE、c-TEE检查,分析患者一般情况,并比较两组间TEE及c-TEE右向左分流阳性结果及c-TEE左房内微气泡来源、分流程度等特征。结果：偏头痛组女性居多,且年龄小于隐源性脑卒中患者(P均＜0.05)。TEE观察到隐源性脑卒中组PFO 患者82例,偏头痛组32例,均未发现肺静脉异常；c-TEE检查中偏头痛组肺相关右向左分流(P-RLS)66例,PFO相关右向左分流(PFO-RLS)80例；隐源性脑卒中组P-RLS 71例,PFO-RLS 96例,c-TEE在偏头痛组的PFO检出率明显高于TEE(P＜0.05),隐源性脑卒中组无明显统计学差异(P>0.05)。两组间c-TEE检查不同类型右向左分流比例无统计学差异(P>0.05),但偏头痛组1级RLS(65/127,51%)显著高于隐源性卒中组(38/153,25%,P＜0.05),其中偏头痛患者的P-RLS和PFO-RLS均显著高于隐源性脑卒中患者( P均＜0.05)；隐源性卒中组3级RLS比例 (51/153,33%)显著高于偏头痛组 (22/127,18%)(P＜0.05),其中隐源性脑卒中组PFO-RLS显著高于偏头痛组(P＜0.05)。结论： c-TEE可明确偏头痛和隐源性脑卒中患者右向左分流来源并进行半定量分析,为病因学诊断提供可靠的影像学依据。

Right-to-left shunt types and semi-quantitative analysis in patients with migraine and cryptogenic stroke

Objective: To analyze the contrast transesophageal echocardiography,c-TEE (c-TEE) characteristics in patients with migraine and cryptogenic stroke and to explore the role of c-TEE in the assessment of different disease right-to-left shunt types. Methods: One hundred and forty-six patients with migraine associated with suspected right-to-left shunt and 167 patients with cryptogenic stroke admitted to our hospital from January 2018 to October 2018 were selected for retrospective analysis. All enrolled patients completed TEE and c-TEE examinations, analyzed the general conditions of patients, and compared the positive results of right-to-left shunt and the characteristics of the source and degree of shunt of microbubbles in the left atrium between the two groups with different examination methods. Results: The migraine group was predominantly female and younger than patients with cryptogenic stroke (all P < 0.05). There were 66 cases of pulmonary-related right-to-left shunts in the migraine group and 71 cases in the cryptogenic stroke group. There was no statistical difference in the proportion of different types of right-to-left shunts between the two groups. 82 cases of PFO were observed in the cryptogenic stroke group and 32 cases in the migraine group by TEE, and no pulmonary vein abnormalities were found in either group. 80 cases of PFO-RLS were observed in the migraine group and 96 cases in the cryptogenic stroke group by c-TEE; there was no statistically significant difference in the detection rate of PFO between TEE and c-TEE in the cryptogenic stroke group. In the migraine group, the c-TEE PFO detection rate was significantly higher than that of TEE (P < 0.05). c-TEE showed that the grade 1 RLS in the migraine group (65/12751%) was significantly higher than that in the cryptogenic stroke group (38/153, 25%), in which both P-RLS and PFO-RLS were significantly higher in the migraine patients than in the cryptogenic stroke patients (both P < 0.05 ); grade 3 RLS in the cryptogenic stroke group (51/153, 33%) was significantly higher than grade 3 RLS in the migraine group (22/127, 18%) (P < 0.05), with PFO-RLS significantly higher in the cryptogenic stroke group than in the migraine group, but the difference in P-RLS between the two groups was not statistically significant. Conclusion: The study initially verified that c-TEE can clarify the source of right-to-left shunt in migraine and cryptogenic stroke patients and perform semi-quantitative analysis to provide a basis for possible etiologic diagnosis.