经颅多普勒发泡试验在卵圆孔未闭合并偏头痛患者筛查中的应用价值

目的探讨经颅多普勒发泡试验(contrast-enhanced transcranial doppler,c-TCD)对于偏头痛患者合并卵圆孔未闭(patent foramen ovale,PFO)筛查中的应用价值。方法选取2014年9月—2018年9月温州医科大学附属第三医院收治的128例偏头痛患者,给予c-TCD、经食道心脏超声(transesophageal echocardiography,TEE)2项检查。以TEE作为PFO诊断的"金标准",比较c-TCD与TEE检查的阳性率,计算c-TCD的阳性预测值、阴性预测值、灵敏度、特异度和准确率。结果 c-TCD与TEE的阳性率差异无统计学意义(40.63%vs. 45.31%,χ~2=0.574,P=0.449); c-TCD的阳性预测率为96.15%,阴性预测率为89.47%,灵敏度为86.21%,特异度为97.14%,准确率为92.19%,Kappa值为0.841。结论 c-TCD是诊断卵圆孔未闭合并偏头痛患者的另一有效手段,在医疗机构条件受到限制,或患者不愿接受TEE的时候,可考虑将c-TCD作为TEE的替代检查。

The value of contrast-enhanced transcranial doppler in screening patients with migraine and patent foramen ovale

Objective To investigate the value of contrast-enhanced transcranial doppler (c-TCD) in the screening of patients with migraine and patent foramen ovale (PFO). Methods A total of 128 migraine patients in the Third Affiliated Hospital of Wenzhou Medical University from September 2014 to September 2018 were enrolled, who were given c-TCD and transesophageal echocardiography(TEE). With TEE as the "gold standard" for PFO diagnosis, the positive rates of c-TCD and TEE were compared, and the positive predictive value, negative predictive value, sensitivity, specificity together with accuracy of c-TCD were calculated. Results There were no statistical differences in the positive rates between c-TCD and TEE(40.63% vs. 45.31%,χ2=0.574,P=0.449); the positive predictive rate of c-TCD was 96.15%, the negative predictive rate was 89.47%, the sensitivity was 86.21%, the specificity was 97.14%, the accuracy 92.19%, and the Kappa value was 0.841. Conclusion c-TCD is another effective method to diagnose patients with migraine and patent foramen ovale. c-TCD may be considered as an alternative to TEE when medical conditions are limited, or patients are reluctant to accept TEE.