经食管右心声学造影在评估先兆性偏头痛患者右向左分流中的应用价值

目的 探讨经食管右心声学造影（cTEE）在检测先兆性偏头痛（MA）患者右向左分流（RLS）及鉴别其来源中的应用价值。方法 前瞻性选取我院神经内科107例MA患者（MA组），另选45例健康志愿者（对照组），应用cTEE观察静息状态和Valsalva动作时有无RLS及其来源，并进行半定量分级，比较两组RLS检出率及分流量。结果 MA组RLS检出率高于对照组（69.2%vs. 17.8%），差异有统计学意义（P<0.01），其中单纯卵圆孔未闭所致右向左分流（PFO-RLS）、单纯肺内右向左分流（P-RLS）及两者同时存在的检出率分别为10.3%、11.2%、39.3%，均高于对照组（4.4%、8.9%、4.4%），差异均有统计学意义（均P<0.05）。两组Ⅱ级+Ⅲ级RLS检出率比较差异有统计学意义（P<0.05）。结论 cTEE在检测MA患者RLS及鉴别其来源中均有一定的应用价值。

Evaluation of assessment of right-to-left shunt by contrast transesophageal echocardiography in patients with migraine with aura

Objective To investigate the role of contrast transesophageal echocardiography (cTEE) in detecting right-to-left shunt (RLS) and identifying its sources in migraine aura (MA), and to study the significance of different RLS types in the etiologies of MA. Methods 107 patients with MA and 45 were enrolled. cTEE was applied to identify whether there were RLS and their sources at rest and during Valsalva maneuver respectively, and to semi-quantitatively grade the shunts.?Results The total incidence of RLS of the patients with MA was higher than that in normal control group (69.2% versus 17.8%, P < 0.05). Besides, the ratio of patients with only PFO-RLS (patent foramen ovale right-to-left shunt, PFO-RLS), only P-RLS (intra-pulmonary right-to-left shunt, P-RLS), and both P-RLS and PFO-RLS detected in MA patients were 10.3%, 19.6%, 39.3%, which were all higher than those in control group (4.4%, 8.9%, 4.4%, all P < 0.05). Furthermore, the ratio of moderate or above RLS in MA group was significantly higher (P < 0.05) than that in healthy volunteers. Conclusion Both P-RLS and PFO-RLS have significant roles in etiologies of MA. cTEE is an objective and effective method for the diagnosis, differentiation, and quantitative analysis of RLS.