C-TCD与C-TTE诊断偏头痛合并心脏右向左分流疾病的价值比较
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Comparison of the clinical value of C-TCD and C-TTE in the diagnosis of migraine with right to left shunt in heart
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    摘要:

    目的 比较增强经颅多普勒超声(c-TCD)和经胸超声心动图右心造影(c-TTE)在诊断偏 头痛合并心脏右向左分流(RLS)疾病的应用价值。方法 以2017 年6—12 月就诊于湖南省脑科医院神 经内科符合偏头痛入选标准的110 例患者为研究对象,分别用c-TTE 和c-TCD 检查上述患者心脏RLS 的阳性率,并以经食道超声心动图右心造影(c-TEE)为金标准,比较两项检查中心脏RLS 的阳性率的不 同。同时根据微气泡量,将c-TCD结果分为3 级,比较不同级别微气泡量的c-TTE 阳性率的差异,并将 卵圆孔未闭(PFO)的直径与微气泡量进行相关性分析。结果 c-TCD 对诊断心脏RLS 阳性率(75.45%) 高于c-TTE(57.27%),差异有统计学意义(χ2=8.092,P=0.004);与c-TEE 相比,c-TTE 检查PFO 的敏感性 69.66%、特异性100%、准确性75.45%。与c-TTE相比,c-TCD 对小量微气泡的检出率高于中及大量微气 泡两组(χ2=4.082,P=0.043 ;χ2=4.271,P=0.039)。经Pearson 相关分析, 62 例c-TTE检查结果为阳性的 患者,其PFO 直径与微气泡量呈中度正相关(r=0.525)。结论 微气泡量随着直径的增加而增加,c-TCD 可作为偏头痛患者心脏有无RLS的首选筛查方法。

    Abstract:

    Objective To make a comparison of the application value of c-TCD and c-TTE in the diagnosis of migraine with right to left shunt( RLS) in heart. Methods A total of 110 cases of patients with migraine cured in Neurology Department of Hu'nan Brain Hospital from June 2017 to December 2017 were selected. The positive rates of RLS in these selected patients were examined by c-TTE and c-TCD respectively, with transesophageal contrast echocardiography( CTEE) as the gold standard. The differences of positive rate of RLS in the two examinations were studied. According to the amount of microbubbles, the c-TCD was divided into 3 levels. The difference of the positive rate of c-TTE in different level of microbubbles were compared. At the same time, the correlation study was carried out between the diameter of Patent Foramen Ovale( PFO) and the amount of microbubbles. Results RLS detection was higher under c-TCD than that under c-TTE( 75.45% vs 57.27%, χ2=8.092, P=0.004). The differences had statistical significance. The c-TTE compared with c-TEE showed: sensitivity 69.66%, specificity 100%, and accuracy 75.40%. The detection of c-TCD in small amounts of microbubbles was significantly higher than that of c-TTE( χ2=4.082, P=0.043;χ2=4.271,P=0.039). After Pearson correlation analysis, a moderately positive correlation was presented between the diameter of PFO and the amount of microbubbles( r=0.525) in 62 patients with positive c-TTE examination. Conclusions The amount of microbubbles increases with the diameter of PFO. C-TCD can be used as the preferred method of screening for migraine patients with or without RLS.

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陈小玮 肖潇 黄远桃. C-TCD与C-TTE诊断偏头痛合并心脏右向左分流疾病的价值比较[J].神经疾病与精神卫生,2018,18(5):
DOI :10.3969/j. issn.1009-6574.2018.05.011.

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  • 在线发布日期: 2018-08-21