经颅多普勒超声联合颈动脉超声诊断缺血性脑血管疾病的价值分析

目的 探讨经颅多普勒超声(transcranial doppler ultrasound,TCD)联合颈动脉超声对于缺血性脑血管疾病的诊断价值,供临床参考。 方法 选取瑞安市人民医院2016年8月-2018年7月神经内科739例缺血性脑血管疾病患者,入院后1周内均给予TCD、颈动脉超声检查和头颈部CT血管造影术(computed tomography angiography,CTA)检查,并以头颈部CTA的检查结果作为最终诊断的参照。比较TCD联合颈动脉超声检查与头颈部CTA检查的阳性率,计算并比较联合检查的阳性预测值、阴性预测值、灵敏度、特异度和准确率。 结果 ①TCD联合颈动脉超声检查与头颈部CTA检查的阳性率差异无统计学意义(49.53% vs. 51.69%,χ2=0.693,P=0.405);②经颅多普勒超声联合颈动脉超声检查相对于头颈部CTA检查的阳性预测率为97.27%,阴性预测率为93.03%,灵敏度为93.19%,特异度为97.20%,准确率为95.13%,Kappa值为0.903。 结论 TCD联合颈动脉超声检查用于缺血性脑血管疾病的诊断准确率与头颈部CTA相当,值得临床推广。 

The value of transcranial Doppler ultrasound combined with carotid ultrasound in the diagnosis of ischemic cerebrovascular disease

Objective To investigate the diagnostic value of transcranial Doppler ultrasound (TCD) combined with carotid ultrasound in ischemic cerebrovascular disease for clinical reference. Methods Total 739 patients with ischemic cerebrovascular disease in the department of neurology in our hospital were enrolled in the study, who were given TCD, carotid ultrasound and CT angiography (CTA) of head and neck within one week after admission, with the results as the reference for the final diagnosis. The positive rates of TCD combined with carotid ultrasonography and CTA were compared. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of combined examinations were calculated. Results ① There were no significant difference in the positive rate between TCD combined with carotid ultrasonography and CTA (49.53% vs. 51.69%, χ2=0.693, P=0.405). ② The positive predictive rate of TCD combined with carotid ultrasound was 97.27%, the negative predictive rate was 93.03%, the sensitivity was 93.19%, the specificity was 97.20%, the accuracy was 95.13%, and the Kappa value was 0.903. Conclusion The diagnostic accuracy of TCD combined with carotid ultrasound for ischemic cerebrovascular disease is close to that of head and neck CTA, which is worthy of clinical promotion.