经胸超声心动图与经颅多普勒超声诊断卵圆孔未闭右向左分流的比较

发布时间：2018-04-13 00:28

本文选题：对比增强经胸超声心动图 + 对比增强经颅多普勒超声　；参考：《吉林大学》2017年硕士论文

【摘要】：背景与目的:卵圆孔未闭(patent foramen ovale,PFO)相关右向左分流占所有右向左分流(right-to-left shunt,RLS)疾病的95%。大量研究表明PFO与一系列脑血管事件相关,机制为卵圆孔未闭使左、右心房形成交通,为反常栓塞提供通道,反常栓子随着右向左反常血流直接进入动脉循环,导致隐源性脑卒中、反复卒中发作、短暂性缺血性发作、偏头痛等疾病。因此临床中对PFO-RLS的诊断及分流量分级评估成为研究热点。由于经食道超声心动图(Transesophageal echocardiography,TEE)检查会引起患者不适感,因此临床初筛PFO时应用TEE并不广泛,目前对比增强经胸超声心动图(Contrast Transthoracic Echocardiography,c-TTE)、对比增强经颅多普勒超声(Contrast Transcranial Doppler,c-TCD)两种检查方法应用广泛,但对于哪种检查方法对PFO的检出及分流量分级评价更有效,不同的研究所持观点不同。因此,本研究收集了因头疼就诊于吉大一院神经内科的患者,并同时、同步进行c-TTE、c-TCD两项检查,以明确两种方法在诊断PFO-RLS及评估RLS分级中的价值。本研究随机入组231名因头疼就诊吉林大学第一医院神经内科患者,均在静息状态、执行传统的Valsalva动作后及执行标准化Valsalva动作后同时、同步进行c-TTE及c-TCD检查。c-TTE及c-TCD均根据造影剂微泡(Microbubbles,MB)数目分为4个等级。并根据c-TCD检查将RLS进行分类。将c-TTE及c-TCD检查的阳性率及RLS半定量分级比较;不同类型RLS的分级比较。结果:本研究入组231名患者,女性158名,占68.4%,男性73名,占31.6%,平均年龄36.9±11.6岁。两种检查方法比较,在RS状态下、传统的Valsalva动作后及标准化Valsalva动作后c-TTE检出RLS阳性率均高于c-TCD,差异均具有统计学意义(P0.001)。评价PFO-RLS分级c-TTE检查优于c-TCD检查且差异有统计学意义(H=6.533 P0.001)。c-TCD检查评价RLS分级固有型RLS(constant RLS)高于激发型RLS(provoked RLS)且差异有统计学意义(Z=-3.832 p0.001);c-TTE检查评价RLS分级程度固有型RLS与激发型RLS差异无统计学意义(Z=-1.234 p=0.217);c-TCD检查将入组患者分为RLS阳性组及RLS阴性组,应用c-TTE检查评价该两组RLS分级阳性组高于阴性组,且差异有统计学意义(Z=-5.150 p0.001)。所有入组患者中检出房间隔膨出瘤(atrial septal aneurysm,ASA)者共5例,执行Valsalva动作后,分流量增大。结论:1:c-TTE检查在诊断PFO-RLS阳性率及评估RLS分级优对象及方法:于c-TCD检查。2:c-TCD检查评价固有型RLS分流量大于激发型RLS,c-TCD对不同类型RLS分级差异对比分析优于c-TTE检查。3:需要进行RLS检查的患者,建议c-TTE与c-TCD两种检查联合应用,既提高诊断PFO-RLS阳性率,也可以评价不同类型RLS分级。4:本研究合并有ASA的PFO-RLS分流量较大,执行Valsalva动作后c-TTE及c-TCD两种检查方法评价RLS分流量均较静息状态下有所增加。
[Abstract]:Background & AIM: the right to left shunt (RLSs) associated with patent foramen ovale (OMQ) accounts for 95% of all right to left shunt (RLSs) diseases.A large number of studies have shown that PFO is related to a series of cerebrovascular events, and the mechanism is that the left and right atrium are communicated by the patent foramen ovale, which provides a channel for abnormal embolism, and abnormal embolus flows directly into the arterial circulation with the right to left abnormal blood flow.Causes cryptogenic stroke, recurrent stroke, transient ischemic attack, migraine and other diseases.Therefore, the diagnosis and flow grading of PFO-RLS has become a hot research topic.Because transesophageal echocardiography can cause discomfort in patients, TEE is not widely used in clinical screening of PFO.At present, contrast-enhanced transthoracic Transthoracic echocardiography and contrast-enhanced transcranial Transcranial Doppler echocardiography c-TCD are widely used. However, these two methods are more effective for the detection and grading of PFO.Different research institutes hold different views.Therefore, this study collected the patients who were admitted to the Department of Neurology for headache, and at the same time, carried out c-TTET c-TCD simultaneously to determine the value of the two methods in the diagnosis of PFO-RLS and the evaluation of RLS grading.In this study, a total of 231 patients in the Department of Neurology, first Hospital of Jilin University, were randomly enrolled in the study. All of them were in resting state, performing traditional Valsalva and performing standardized Valsalva at the same time.C-TTE and c-TCD were performed simultaneously. C-TTE and c-TCD were divided into four grades according to the number of microbubbles.RLS was classified according to c-TCD examination.The positive rate of c-TTE and c-TCD and the semi-quantitative grading of RLS were compared, and the grades of different types of RLS were compared.Results: there were 231 patients in this study, 158 women (68.4%), 73 males (31.66.6years) with an average age of 36.9 卤11.6 years.The positive rate of RLS detected by traditional Valsalva and standardized Valsalva was higher than that of c-TCD.The difference was statistically significant (P 0.001).The evaluation of PFO-RLS grade c-TTE was better than c-TCD, and the difference was statistically significant. The evaluation of RLS grading intrinsic RLS(constant was higher than that of exciting RLS(provoked by P0.001).c-TCD 6.533 P0.001).c-TCD examination, and the difference was statistically significant.There was no significant difference in type type RLS. The patients were divided into RLS positive group and RLS negative group.The RLS grading positive group was higher than the negative group by c-TTE examination, and the difference was statistically significant.In all the patients, atrial septal neoplasms (ASA) were detected in 5 cases. After Valsalva, the flow was increased.Conclusion the diagnostic positive rate of PFO-RLS and the evaluation of RLS grade were evaluated by 1: 1 / c-TTE. Methods: in c-TCD examination, the partial flow of RLS was larger than that of activated RLSc-TCD, and the difference between different RLS grades was better than that of c-TTE. 3: it was necessary to evaluate the difference between different RLS grades. 3: 1: 2: TCD was better than RLSc-TCD in evaluating the flow of RLS in different types of RLS.Patients undergoing RLS,It is suggested that the combination of c-TTE and c-TCD can not only improve the positive rate of PFO-RLS diagnosis, but also evaluate the different types of RLS grade. 4. In this study, the PFO-RLS shunt volume with ASA is larger.Both c-TTE and c-TCD methods were used to evaluate the flow of RLS after Valsalva.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R541.1

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