中国实用神经疾病杂志2017，Vol.20Issue(24)：25-31,7.DOI:10.3969/j.issn.1673-5110.2017.24.006
不明原因中青年脑梗死RLS诊断cTCD和cTTE对比研究
Comparative study of cTCD and cTTE in the diagnosis of RLS in young and middle aged cerebral infarction pa-tients unexplained
摘要
Abstract
Objective To investigate the diagnosis value of cTCD(contrast-enhanced transcranial Doppler) and cTTE(con-trast-enhanced transthoracic echocardiography ) for RLS(right-to-left shunts) in young and middle aged cerebral infarction patients unexplained .Methods A total of 166 young and middle aged cerebral infarction patients unexplained in our hospital from January 2015 to September 2017 were collected .By taking the physiological saline activating via elbow intravenous injection as a contrast a-gent ,and combined with Valsalva maneuver ,all patients were simultaneously performed the cTCD and cTTE examination to diag-nose whether the RLS existed .RLS was divided into the inherent and potential shunt based on whether there was a shunt at resting state or after Valsalva maneuver .If the grade of the inherent shunt after Valsalva maneuver reached to a higher level ,the higher level would be adopted .Results The RLS was detected by cTCD in the 80 (48 .19% ) of 166 patients and by cTTE in the 68 (40.96% ) of 166 patients .The difference was statistically significant (P< 0.005) .The RLS was detected by cTCD in the 27 (16.27% ) of 166 patients at resting state and in the 80 (48 .19% ) of 166 patients after Valsalva maneuver .The detection rate of RLS after Valsalva maneuver was significantly higher than that at resting state (P<0.005) .The RLS was detected by cTTE in the 28 (16.87% ) of 166 patients at resting state and in the 68 (41.76% ) of 166 patients after Valsalva maneuver .The detection rate of RLS after Valsalva maneuver was significantly higher than that at resting state (P<0.005) .The results of the semi-quan-titative classification of cTCD showed that 26(15.66% ) cases in the small shunt of level one ,26(15.66% ) cases in the medium shunt of level two and 28 (16.87% ) cases in the large shunt of level three .The results of the semi-quantitative classification of cTTE showed that 27(16.27% ) cases in the small shunt of level one ,19(16.87% ) cases in the medium shunt of level two and 22 (13.25% ) cases in the large shunt of level three .The results showed that the difference of the classification between the two methods was statistically significant (the value of the Bower test was 14.818 ,P=0.011) and the detection level of RLS by cTCD was higher than that by cTTE .Conclusion Both cTCD and cTTE can diagnose whether the patient has the RLS and determine the grade of RLS .However ,cTCD has higher positive rates than cTTE ,the detection rate of RLS after Valsalva maneuver is signifi-cantly higher than that at resting state ,the results of the semi-quantiative classification are different and the detection level of RLS by cTCD is higher than that by cTTE .Therefore ,cTCD is more suitable as the initial screening method of RLS .关键词
增强TCD/TTE声学造影/右向左分流/隐源性卒中/卵圆孔未闭Key words
Contrast-enhanced transcranial Doppler/Contrast-enhanced transthoracic echocardiography/Right-to-left shunts/Cryptogenic stroke/Patent foramen ovale分类
医药卫生引用本文复制引用
宋彬彬,段智慧,杜艳娇,王瑞琼,商丹丹,李丽..不明原因中青年脑梗死RLS诊断cTCD和cTTE对比研究[J].中国实用神经疾病杂志,2017,20(24):25-31,7.基金项目
河南省科技攻关计划(1503006 A-1 ) （1503006 A-1 ）
