P选择素联合右心声学造影诊断偏头痛合并卵圆孔未闭患者的价值

目的  分析P选择素联合右心声学造影（cTTE）诊断偏头痛合并卵圆孔未闭患者的价值。方法  选取2019年4月~2021年4月我院收治的64例偏头痛患者，根据是否并发卵圆孔未闭分为发生组47例，未发生组17例，比较所有患者血清中的P选择素水平，并进行右心声学造影检查，比较不同检查方法的诊断准确率。结果  并发卵圆孔未闭患者P选择素水平明显高于未发卵圆孔未闭患者，差异有统计学意义（P < 0.05）；以术中封堵为金标准，P选择素诊断偏头痛合并卵圆孔未闭的敏感度为68.09%、特异性为82.35%、阳性预测值为91.43%、阴性预测值为48.28%、诊断符合率为71.88%，一致性为0.412；以术中封堵为金标准，P选择素联合cTTE诊断偏头痛合并卵圆孔未闭的敏感度为82.98%、特异性为88.24%、阳性预测值为95.12%、阴性预测值为65.22%、诊断符合率为84.38%，一致性为0.640。结论  P选择素联合右心声学造影有利于提高偏头痛合并卵圆孔未闭患者的诊断准确率，在临床上有一定的应用价值。

Value of P- selection combined with right echocardiography in the diagnosis of patients with migraine with unclosed foramen ovale

  Objective  To analyze the value of P-selection combined with right echocardiography (cTTE) diagnosing patients with migraine combined with unclosed foramen ovale.  Methods  A total of 64 migraine patients admitted to our hospital from April 2019 to April 2021 were selected and divided into the occurrence group (n=47) and the non-occurrence group (n=17) according to the complication of patent foramina ovale. The serum P-selection levels of all patients was compared, and right echocardiography was performed to compare the diagnostic accuracy of different examination methods.  Results  The levels of P selectin were significant higher in patients with patent foramen ovale than in those without patent foramen ovale, with a statistically significant difference (P < 0.05). Using intraoperative closure as the gold standard, the sensitivity of P-selectin for the diagnosis of migraine combined with oval foramen nonocclusion was 68.09%, specificity was 82.35%, positive predictive value was 91.43%, negative predictive value was 48.28%, and diagnostic compliance rate was 71.88% and concordance 0.412. Using intraoperative closure as the gold standard, the sensitivity of P-selectin combined with cTTE for the diagnosis of migraine combined with patent foramen ovale was 82.98%, specificity was 88.24%, positive predictive value was 95.12%, negative predictive value was 65.22%, diagnostic compliance was 84.38%, with a consistency of 0.640.  Conclusion  P-selection combined with right aspiration imaging can improve the diagnostic accuracy in patients with migraine combined with unclosed foramen ovale.