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

Imaging diagnosis of cryptogenic cerebral apoplexy combined with patent foramen ovale

摘要:

目的 探讨卵圆孔未闭（PFO）伴隐源性缺血性脑卒中（CS）临床特点及不同影像学检查方法 的优劣，研究卵圆孔未闭与隐源性脑卒中的相关性。方法 选取2013 年1 月—2017 年10 月南昌大学第三附 属医院收治的不明原因急性CS 患者156 例作为观察组，同时选取与观察组年龄、性别相匹配的健康体检者 148 例作为对照组。两组均行经胸右心声学造影和经颅多普勒对比增强试验（cTCD）诊断PFO，并比较两组 PFO 及PFO 合并房间隔瘤（ASA）的发病率。以手术封堵结果为金标准，分析观察组中经胸右心声学造影和 经颅cTCD 两种检测方法有无差异。结果 观察组的PFO 及PFO 合并ASA 检出率与对照组比较，差异有统 计学意义（P <0.05），观察组高于对照组；以手术结果为金标准，cTCD 检出PFO 的敏感性、特异性、准确 性分别为75.8%（50/66）、88.9%（80/90）和83.3%（130/156）；经胸右心声学造影检出PFO 的敏感性、特异性、 准确性分别为90.9%（60/66）、94.4%（85/90）和92.9%（145/156）。经胸右心声学造影在不明原因急性CS 患 者中检出PFO 的敏感性、准确性均优于cTCD（P <0.05）。结论 不明原因急性CS 患者PFO 发病率高于正 常健康人群，其检查方法首选右心声学造影。经胸右心声学造影及cTCD 诊断卵圆孔未闭具有确切的临床应 用价值。

Abstract:

Objective To investigate different imaging methods for diagnosis of patent foramen ovale (PFO) with cryptogenic ischemic stroke (CS). Methods A retrospective analysis was carried out on 156 cases of acute ischemic stroke and 148 healthy subjects who were admitted into our hospital during January 2013 to October 2017. Chest right heart contrast echocardiography and transcranial Doppler contrast enhancement test (cTCD) were performed on all individuals. The incidence of PFO and atrial septal aneurysm (ASA) were identified. Diagnostic efficacy of two methods was evaluated. Results Incidence of PFO and PFO with ASA were higher in patient group than that in healthy control group (P < 0.05). Sensitivity, specificity, and accuracy of cTCD was 75.8% (50/66),88.9% (80/90), and 83.3% (130/156), respectively. Sensitivity, specificity, and accuracy of transthoracic right heart contrast echocardiography was 90.9% (60/66), 94.4% (85/90), and 92.9% (145/156), respectively. Transthoracic right heart contrast echocardiography exerted superiority in detecting PFO than cTCD did (P < 0.05). Conclusions The incidence of PFO in patients with of unknown acute ischemic stroke is higher than that of normal healthy people. Right heart acoustic contrast is superior to cTCD in diagnosis of the patent foramen ovale.