经颅多普勒超声发泡试验筛查卵圆孔未闭致隐源性脑卒中的应用价值

毛樱; 王芳; 池菊芳; 钟芳芳

doi:10.16766/j.cnki.issn.1674-4152.002513

经颅多普勒超声发泡试验筛查卵圆孔未闭致隐源性脑卒中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.002513

毛樱¹,
王芳^1, ,,
池菊芳²,
钟芳芳³

1.
绍兴市人民医院特殊检查室，浙江绍兴 312000
2.
绍兴市人民医院心内科，浙江绍兴 312000
3.
绍兴市人民医院神经内科，浙江绍兴 312000

基金项目:

浙江省卫生健康科技计划项目 2021KY360

详细信息

通讯作者:
王芳，E-mail：cmk5678112@163.com

中图分类号: R743.3 R445.1
计量
- 文章访问数: 296
- HTML全文浏览量: 311
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-03
- 网络出版日期: 2022-09-21

Application value of transcranial Doppler ultrasound foaming test in screening cryptogenic stroke caused by patent foramen ovale

1.
Special Examination Room of Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析经颅多普勒超声发泡试验(C-TCD)筛查卵圆孔未闭(PFO)致隐源性脑卒中(CS)的应用价值。方法选取2017年1月—2021年6月绍兴市人民医院收治的204例CS患者，所有患者均行C-TCD与经食管超声心动图(TEE)检查，比较其PFO阳性检出率；根据C-TCD的PFO检出情况，将阳性者纳入阳性组，阴性者纳入阴性组，分析阳性组患者的微气泡信号分级，比较2组患者的血管分布区影像特征(前循环、后循环、前后联合循环、大脑前动脉、大脑中动脉、椎基底动脉)及各区域影像学特征(皮层/皮层下区域、深部灰质区域、幕下区域)。结果 C-TCD的PFO阳性检出率为55.39%(113/204)，高于TEE检查[42.65%(87/204)，P＜0.05]。C-TCD检出PFO阳性113例，其中包括0级26例(23.01%)，Ⅰ级34例(30.09%)，Ⅱ级27例(23.89%)，Ⅲ级26例(23.01%)。阳性组与阴性组前循环、后循环、前后联合循环、大脑前动脉、大脑中动脉、椎基底动脉的分布比较差异无统计学意义(均P＞0.05)。阳性组皮层/皮层下区域的检出率为57.52%，高于阴性组的27.59%(P＜0.05)；阳性组深部灰质区域的检出率为22.12%，低于阴性组的40.23%(P＜0.05)；阳性组幕下区域的检出率为14.16%，与阴性组的16.09%相近(P＞0.05)。结论 C-TCD在PFO致CS筛查中可发挥一定的作用，患者病变多分布于皮层/皮层下区域，可作为CS病因筛查手段。
- 经颅多普勒超声发泡试验 /
- 卵圆孔未闭 /
- 隐源性脑卒中 /
- 筛查 /
- 应用价值
Abstract: Objective To analyse the application value of transcranial Doppler ultrasound foaming test (C-TCD) in screening cryptogenic stroke (CS) caused by patent foramen ovale (PFO). Methods A total of 204 patients with CS treated in Shaoxing People's Hospital from January 2017 to June 2021 were examined by C-TCD and transoesophageal echocardiography (TEE), and the positive detection rate of PFO was compared. According to the PFO detection of C-TCD, the positive patients were included in the positive group, and the negative patients in the negative group. The microbubble signal classification of the patients in the positive group was analysed, and the imaging characteristics of the vascular distribution areas (anterior circulation, posterior circulation, combined anterior and posterior circulation, anterior cerebral artery, middle cerebral artery and vertebrobasilar artery) and each region were compared between the two groups. Results The positive rate of PFO in C-TCD was 55.39% (113/204), which was higher than that in TEE (42.65%, 87/204, P < 0.05). A total of 113 cases of PFO were positive in C-TCD, including 26 cases of grade 0 (23.01%), 34 cases of grade Ⅰ (30.09%), 27 cases of grade Ⅱ (23.89%) and 26 cases of grade Ⅲ (23.01%). There was no significant difference in the distribution of anterior circulation, posterior circulation, combined anterior and posterior circulation, anterior cerebral artery, middle cerebral artery and vertebrobasilar artery in the positive and negative groups (P>0.05). The detection rate of cortical/subcortical area in the positive group was 57.52%, which was higher than that in the negative group (27.59%), P < 0.05. The detection rate of deep grey matter in the positive group was 22.12%, which was lower than that in the negative group (40.23%), P < 0.05. The detection rate of infratentorial area in the positive group was 14.16%, which was close to that in the negative group (16.09%), P>0.05. Conclusion C-TCD has a certain application value in the screening of CS caused by PFO. Patients' lesions are mostly distributed in cortical/subcortical areas, which can be used as a means of screening the aetiology of CS.
- Contrast transcranial Doppler ultrasound foaming test /
- Patent foramen ovale /
- Cryptogenic stroke /
- Screening /
- Application value

HTML全文

表 1 2组隐源性脑卒中患者血管分布区影像特征比较[例(%)]

Table 1. Comparison of image characteristics of vascular distribution area in 2 groups of cryptogenic stroke patients [cases (%)]

组别	例数	前循环	后循环	前后联合循环	大脑前动脉	大脑中动脉	椎基底动脉
阳性组	113	66(58.41)	41(36.28)	9(7.96)	8(7.08)	57(50.44)	41(36.28)
阴性组	87	49(56.32)	30(34.48)	8(9.20)	6(6.90)	43(49.43)	30(34.48)
χ²值		0.087	0.070	0.096	0.003	0.020	0.070
P值		0.767	0.792	0.757	0.960	0.887	0.792

下载: 导出CSV

表 2 2组隐源性脑卒中患者各区域影像学特征比较[例(%)]

Table 2. Comparison of imaging characteristics of each region in 2 groups of cryptogenic stroke patients [cases (%)]

组别	例数	皮层/皮层下区域	深部灰质区域	幕下区域
阳性组	113	65(57.52)	25(22.12)	16(14.16)
阴性组	87	24(27.59)	35(40.23)	14(16.09)
χ²值		17.836	7.673	0.144
P值		＜0.001	0.006	0.704

下载: 导出CSV

参考文献(22)

[1]	余新艳, 吴丹. 经颅多普勒超声发泡实验(c-TCD)阳性的隐源性卒中(CS)患者临床及影像学特点[J]. 吉林医学, 2019, 40(3): 607-608. doi: 10.3969/j.issn.1004-0412.2019.03.087 YU X YAN, WU D. Clinical and imaging characteristics of cryptogenic stroke (CS) patients with positive transcranial Doppler ultrasound foaming test (c-TCD)[J]. Jilin Med J, 2019, 40(3): 607-608. doi: 10.3969/j.issn.1004-0412.2019.03.087
[2]	段景怡, 陈蓓蓓. C-TCD阳性的隐源性卒中的临床及影像学特点[J]. 中国卒中杂志, 2017, 12(8): 686-690. doi: 10.3969/j.issn.1673-5765.2017.08.006 DUAN J Y, CHEN B B. Clinical and imaging characteristics of cryptogenic stroke with positive c-TCD[J]. Chin J Strok, 2017, 12(8): 686-690. doi: 10.3969/j.issn.1673-5765.2017.08.006
[3]	刘婷婷, 宋嫣. 发泡实验及经食道超声在卵圆孔未闭中的诊断价值[J]. 中国医学创新, 2019, 16(1): 145-148. doi: 10.3969/j.issn.1674-4985.2019.01.039 LIU T T, SONG Y. Diagnostic value of foaming experiment and transesophageal ultrasound in patent foramen ovale[J]. Chin Med Innov, 2019, 16(1): 145-148. doi: 10.3969/j.issn.1674-4985.2019.01.039
[4]	余新艳, 杨建云. 经颅多普勒发泡试验筛查卵圆孔未闭致隐源性脑卒中的临床价值[J]. 中西医结合心脑血管病杂志, 2020, 18(21): 3676-3678. doi: 10.12102/j.issn.1672-1349.2020.21.043 YU X Y, YANG J Y. Clinical value of transcranial Doppler foaming test in screening cryptogenic stroke caused by patent foramen ovale[J]. J Integr Trad Chin & West Med, 2020, 18(21): 3676-3678. doi: 10.12102/j.issn.1672-1349.2020.21.043
[5]	张春丽, 高红红, 李科信, 等. TCD发泡试验对青年隐源性卒中病因诊断的临床意义[J]. 中西医结合心脑血管病杂志, 2018, 16(18): 2731-2732. doi: 10.12102/j.issn.1672-1349.2018.18.043 ZHANG C L, GAO H H, LI K X, et al. Clinical significance of TCD foaming test in the etiological diagnosis of cryptogenic stroke in young people[J]. J Card Cerebrov Dis With Integr Tradit Chin & West Med, 2018, 16(18): 2731-2732. doi: 10.12102/j.issn.1672-1349.2018.18.043
[6]	陈文鑫, 黄妙珊, 陈汉杰, 等. 经颅多普勒超声发泡试验与经胸心脏超声心动图检查对中青年隐源性卒中卵圆孔未闭诊断价值比较[J]. 中国临床新医学, 2018, 11(3): 234-237. doi: 10.3969/j.issn.1674-3806.2018.03.07 CHEN W X, HUANG M S, CHEN H J, et al. Comparison between transcranial Doppler ultrasound foaming test and transthoracic echocardiography in the diagnosis of patent foramen ovale in young and middle-aged cryptogenic stroke[J]. China New Clin Med, 2018, 11(3): 234-237. doi: 10.3969/j.issn.1674-3806.2018.03.07
[7]	史丽娜, 于成超, 成江, 等. 经颅多普勒发泡实验在筛查隐源性卒中合并卵圆孔未闭的应用价值[J]. 中风与神经疾病杂志, 2017, 34(1): 48-50. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ201701011.htm SHI L N, YU C C, CHENG J, et al. Application value of transcranial Doppler foaming test in screening cryptogenic stroke with patent foramen ovale[J]. J Stroke & Neurol Dis, 2017, 34(1): 48-50. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ201701011.htm
[8]	王文秀, 吴海琴. TCD发泡试验联合CTA筛查青年缺血性脑卒中病因的应用研究[J]. 中西医结合心脑血管病杂志, 2019, 17(4): 597-599. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201904034.htm WANG W X, WU H Q. Study on the application of TCD foaming test combined with CTA in screening the etiology of ischemic stroke in young people[J]. J Card Cerebr Dis With Integr Tradit Chin & West Med, 2019, 17(4): 597-599. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201904034.htm
[9]	秦莉花, 黄娟, 李晟, 等. 脑卒中流行病学及与性激素的相关性[J]. 中国老年学杂志, 2018, 38(20): 5099-5103. doi: 10.3969/j.issn.1005-9202.2018.20.088 QIN L H, HUANG J, LI S, et al. Stroke epidemiology and its correlation with sex hormones[J]. Chin J Geront, 2018, 38(20): 5099-5103. doi: 10.3969/j.issn.1005-9202.2018.20.088
[10]	王亚楠, 吴思缈, 刘鸣. 中国脑卒中15年变化趋势和特点[J]. 华西医学, 2021, 36(6): 803-807. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202106017.htm WANG Y N, WU S M, LIU M. Trends and characteristics of stroke in China in the past 15 years[J]. West China Med, 2021, 36(6): 803-807. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202106017.htm
[11]	刘龙龙, 李霞, 李珊珊, 等. TCD发泡试验对不明原因青年卒中病人病因检出的意义[J]. 中西医结合心脑血管病杂志, 2018, 16(18): 2729-2730. doi: 10.12102/j.issn.1672-1349.2018.18.042 LIU L L, LI X, LI S S, et al. Significance of TCD foaming test in detecting the etiology of unexplained young stroke patients[J]. J Integr Tradit Chin & West Med, 2018, 16(18): 2729-2730. doi: 10.12102/j.issn.1672-1349.2018.18.042
[12]	李岚欣, 徐世成. 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[J]. 临床军医杂志, 2017, 45(7): 694-697. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201707012.htm LI L X, XU S C. Clinical application value of transcranial Doppler ultrasound foaming test in screening migraine patients with patent foramen ovale[J]. J Clin Milit Med, 2017, 45(7): 694-697. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201707012.htm
[13]	张永银, 陈伟莉, 陈光勇, 等. 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[J]. 中华全科医学, 2019, 17(4): 637-640. doi: 10.16766/j.cnki.issn.1674-4152.000755 ZHANG Y Y, CHEN W L, CHEN G Y, et al. Application value of transcranial Doppler foaming test in screening patients with patent foramen ovale and migraine[J]. Chin Gen Pract, 2019, 17(4): 637-640. doi: 10.16766/j.cnki.issn.1674-4152.000755
[14]	李存, 习新聪, 张函, 等. 卵圆孔未闭所致急性缺血性脑血管病影像学特征的早期临床诊断价值[J]. 华中科技大学学报(医学版), 2020, 49(3): 307-311. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYX202003011.htm LI C, XI X C, ZHANG H, et al. Early clinical diagnostic value of imaging features of acute ischemic cerebrovascular disease caused by patent foramen ovale[J]. J Huazhong Univers Science & Techn (Med Edit), 2020, 49(3): 307-311. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYX202003011.htm
[15]	邵珲, 杜亚娟, 宋强, 等. 卵圆孔未闭(右向左分流)与隐源性缺血性脑卒中的关系及筛检评价[J]. 心脏杂志, 2020, 32(5): 502-505, 512. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ202005012.htm SHAO H, DU Y J, SONG Q, et al. Relationship between patent foramen ovale(right to left shunt) and cryptogenic ischemic stroke and screening evaluation[J]. Heart J, 2020, 32(5): 502-505, 512. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ202005012.htm
[16]	关爽, 董齐, 伊然, 等. 卵圆孔未闭相关性隐源性脑卒中的研究进展[J]. 中国临床神经科学, 2020, 28(1): 93-99. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSK202001015.htm GUAN S, DONG Q, YI R, et al. Research progress of cryptogenic stroke associated with patent foramen ovale[J]. Chin J Clin Neurosc, 2020, 28(1): 93-99. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSK202001015.htm
[17]	马利, 王娟娟, 刘莹莹. 经颅多普勒发泡试验在卵圆孔未闭合并偏头痛患者筛查及封堵术疗效评估中的应用价值[J]. 中国医药导报, 2017, 14(25): 127-130. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201725032.htm MA L, WANG J J, LIU Y Y. Application value of transcranial Doppler foaming test in screening and efficacy evaluation of occlusion in patients with patent foramen ovale complicated with migraine[J]. China Med Herald, 2017, 14(25): 127-130. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201725032.htm
[18]	常嵘, 赵艺娜, 杨敏. TCD联合TTE发泡试验在不明原因脑血管病因筛查中的应用[J]. 心脑血管病防治, 2017, 17(1): 44-45. https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ201701016.htm CHANG R, ZHAO Y N, YANG M. Application of TCD combined with TTE foaming test in the screening of unknown cerebrovascular etiology[J]. Prevent & Treatm Cardiov & Cerebrov Dis, 2017, 17(1): 44-45. https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ201701016.htm
[19]	王素平, 黄维星, 王东, 等. TCD发泡试验对偏头痛合并卵圆孔未闭的诊断价值[J]. 神经损伤与功能重建, 2018, 13(12): 652-653, 661. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201812019.htm WANG S P, HUANG W X, WANG D, et al. Diagnostic value of TCD foaming test in migraine with patent foramen ovale[J]. Nerv Injury & Funct Reconstr, 2018, 13(12): 652-653, 661. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201812019.htm
[20]	迟蕊, 张美艳, 潘心, 等. C-TCD与TEE在筛选卵圆孔未闭相关性隐源性卒中中的诊断价值[J]. 临床医学研究与实践, 2020, 5(11): 127-128. CHI R, ZHANG M Y, PAN X, et al. Diagnostic value of c-TCD and tee in screening cryptogenic stroke associated with patent foramen ovale[J]. Clin Med Res & Pract, 2020, 5(11): 127-128.
[21]	王豪, 孙园园, 邓雅琴, 等. 隐源性缺血性脑卒中合并卵圆孔未闭的临床及影像学检查分析[J]. 中国现代医学杂志, 2019, 29(1): 67-70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201901014.htm WANG H, SUN Y Y, DENG Y Q, et al. Clinical and imaging analysis of cryptogenic ischemic stroke with patent foramen ovale[J]. Chin J Mod Med, 2019, 29(1): 67-70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201901014.htm
[22]	江毓敏, 刘强, 陈世英, 等. 合并卵圆孔未闭的隐源性脑卒中患者的临床研究[J]. 宁夏医科大学学报, 2017, 39(3): 260-263. https://www.cnki.com.cn/Article/CJFDTOTAL-XNXY201703007.htm JIANG Y M, LIU Q, CHEN S Y, et al. Clinical study of cryptogenic stroke patients with patent foramen ovale[J]. J Ningxia Med Univ, 2017, 39(3): 260-263. https://www.cnki.com.cn/Article/CJFDTOTAL-XNXY201703007.htm