经颅多普勒发泡试验筛查缺血性卒中合并卵圆孔未闭的应用价值

目的探讨经颅多普勒发泡试验(c-TCD)筛查缺血性卒中合并卵圆孔未闭(PFO)的应用价值。方法收集我院神经内科450例缺血性卒中患者,均给予经食管心脏超声(TEE)、右心声学造影、c-TCD检查。观察c-TCD、TEE联合经右心声学造影检查PFO的阳性率。将TEE联合经右心声学造影检查结果视为PFO诊断的"金标准",计算c-TCD的阳性预测值、阴性预测值、灵敏度、特异度及准确率。结果 TEE联合经右心声学造影检查显示,阳性为72例,阳性率为16.00%,即450例患者中,PFO的发生率为16.00%;c-TCD检查显示,65例清晰可见微栓子信号,阳性率为14.44%,c-TCD与TEE联合经右心声学造影检查阳性率比较差异无统计学意义(P>0.05);c-TCD相对于TEE联合经右心声学造影的阳性预测值为96.92%、阴性预测值为97.66%、灵敏度为87.50%、特异度为99.47%、准确率为97.56%、一致性Kappa值为0.837。结论 c-TCD在筛查诊断缺血性卒中合并PFO中具有灵敏度、特异度、准确率高的特点,且无创、安全,易于患者接受,可考虑将c-TCD作为PFO的无创初筛手段,针对阳性患者再进一步做TEE+经右心声学造影检查确诊,以减轻患者的痛苦。

Application Value of c-TCD in Screening Ischemic Stroke With Patent Foramen Ovale

Objective To explore the application value of contrast-enhanced transcranial doppler(c-TCD) in screening ischemic stroke with patent foramen ovale(PFO). Methods 450 patients with ischemic stroke admitted from in neurology department of our hospital were all given transesophageal echocardiography(TEE), right ventriculography and c-TCD examination. To observe the positive rate of PFO detected by c-TCD and TEE combined with right ventriculography. The results of TEE combined with right ventriculography were regarded as the"gold standard" for PFO diagnosis, and the positive predictive value, negative predictive value, sensitivity, specificity and accuracy of c-TCD were calculated. Results TEE combined with right ventriculography showed that 72 cases were positive, and the positive rate was 16.00%, which means that the incidence of PFO in 450 patients was 16.00%. c-TCD showed that 65 cases clearly showed microembolic signals, with a positive rate of 14.44%. There was no significant difference in the positive rate of c-TCD and TEE combined with right ventriculography(P>0.05). The positive predictive value, negative predictive value, sensitivity, specificity, accuracy and Kappa value of c-TCD are 96.92%, 97.66%, 87.50%, 99.47%, 97.56% and 0.837 respectively compared with TEE combined with right heart angiography. Conclusions c-TCD has the characteristics of high sensitivity, specificity and accuracy in screening and diagnosing ischemic stroke complicated with PFO. It is noninvasive, safe and easy for patients to accept. Therefore, c-TCD can be considered as a routine screening method for ischemic stroke complicated with PFO.