经颅多普勒超声发泡试验在筛查偏头痛合并卵圆孔未闭患者中临床应用价值

目的探讨经颅多普勒超声发泡试验(c-TCD)在偏头痛患者中筛查卵圆孔未闭(PFO)的可行性,旨在为筛查PFO、偏头痛诊疗等提供参考。方法选择2014年1月至2015年12月收治的偏头痛患者110例为研究对象。本组患者均行c-TCD、经胸超声心动图(TTE)、头颅CT或MRI检查,TTE检查阴性者再行经食管超声心动图(TEE)检查,对检出的PFO患者行介入封堵治疗。评价c-TCD诊断PFO的灵敏度及特异度,比较先兆偏头痛(MA)、非先兆偏头痛(MO)患者PFO的检出情况。对行封堵治疗的患者,术后随访3个月,观察患者偏头痛有无缓解或疼痛情况,并行c-TCD、TTE及头部CT等检查。结果 110例偏头痛患者中检出PFO患者43例,检出率为39.1%,c-TCD诊断PFO的特异度为100.0%、灵敏度为95.4%。MA、MO患者中,PFO检出率为47.0%、27.3%(χ~2=4.30,P<0.05)。27例(MA 18例,MO 9例)患者接受了介入封堵治疗,均一次性封堵成功,术后无并发症,术后随访3个月,19例偏头痛症状消失,8例缓解,头部CT未见新发梗死病灶。结论 c-TCD在筛查偏头痛合并PFO患者中具有较高的临床价值,c-TCD诊断PFO具有较高的灵敏度及特异度,且具有无创、方便、安全等优点,患者易于接受。对于合并PFO的偏头痛患者,封堵治疗具有较好的临床效果,能够消除或缓解偏头痛症状。

Clinical value of screening patent foramen ovale in patients with migraine by contrast enhanced transcranial doppler

Objective To investigate the feasibility of screening patent foramen ovale (PFO) in patients with migraine by contrast en hanced transcranial doppler(c-TCD),and to provide reference for PFO's screen,migraine's diagnosis and treatment.Methods A retrospective study was performed on 110 patients with migraine who were admitted from January 2014 to December 2015.Patients were all given c-TCD,transthoratic echocardiography(TTE),head CT or MRI tests,and patients with negative results of TTE were given transesophageal echocardiography(TEE),and transcatheter closure therapy were adopted for patients with PFO.Sensitivity and speci ficity on diagnosis of PFO by c-TCD were evaluated,PFO morbidity in patients of migraine with aura(MA) and non migraine with aura (MO) were compared.For patients undergoing transcatheter closure therapy,they were followed up for 3 months after surgery to observe migraine changes,and were given test of c-TCD,TTE and head CT.Results There were 43 cases with PFO were detected in 110 cases with migraine,the detection rate was 39.1％,the specificity was 100.0％ and the sensitivity was 95.4％ on diagnosis of PFO by c-TCD.PFO detection rate in MA and MO patients was 47.0％ and 27.3％ (x2 =4.30,P ＜0.05).There were 27 cases with PFO(18 cases of MA and 9 cases of MO) were given transcatheter closure therapy,and they were given one-time plugging success without postoperative complications.In 3 months of follow up,there were 19 cases without migraine symptoms and 8 cases with symp toms remission,without new infarction lesions detected by head CT.Conclusion It has high clinical value on screening PFO in patients with migraine by c-TCD,with higher sensitivity and specificity,and with advantages of non-invasive,convenient,safe,and easy to be acceptted.For migraine patients with PFO,transcatheter closure therapy has good clinical effect,which can eliminate or alleviate the symptoms of migraine.