经颅多普勒超声联合颈动脉超声诊断缺血性脑血管疾病的价值分析
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摘要
目的探讨经颅多普勒超声(transcranial doppler ultrasound,TCD)联合颈动脉超声对于缺血性脑血管疾病的诊断价值,供临床参考。方法选取瑞安市人民医院2016年8月—2018年7月神经内科739例缺血性脑血管疾病患者,入院后1周内均给予TCD、颈动脉超声检查和头颈部CT血管造影术(computed tomography angiography,CTA)检查,并以头颈部CTA的检查结果作为最终诊断的参照。比较TCD联合颈动脉超声检查与头颈部CTA检查的阳性率,计算并比较联合检查的阳性预测值、阴性预测值、灵敏度、特异度和准确率。结果①TCD联合颈动脉超声检查与头颈部CTA检查的阳性率差异无统计学意义(49.53%vs. 51.69%,χ~2=0.693,P=0.405);②经颅多普勒超声联合颈动脉超声检查相对于头颈部CTA检查的阳性预测率为97.27%,阴性预测率为93.03%,灵敏度为93.19%,特异度为97.20%,准确率为95.13%,Kappa值为0.903。结论 TCD联合颈动脉超声检查用于缺血性脑血管疾病的诊断准确率与头颈部CTA相当,值得临床推广。
Objective To investigate the diagnostic value of transcranial Doppler ultrasound(TCD) combined with carotid ultrasound in ischemic cerebrovascular disease for clinical reference. Methods Total 739 patients with ischemic cerebrovascular disease in the department of neurology in our hospital were enrolled in the study, who were given TCD, carotid ultrasound and CT angiography(CTA) of head and neck within one week after admission, with the results as the reference for the final diagnosis. The positive rates of TCD combined with carotid ultrasonography and CTA were compared. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of combined examinations were calculated. Results ① There were no significant difference in the positive rate between TCD combined with carotid ultrasonography and CTA(49.53% vs. 51.69%, χ~2=0.693, P=0.405). ② The positive predictive rate of TCD combined with carotid ultrasound was 97.27%, the negative predictive rate was 93.03%, the sensitivity was 93.19%, the specificity was 97.20%, the accuracy was 95.13%, and the Kappa value was 0.903. Conclusion The diagnostic accuracy of TCD combined with carotid ultrasound for ischemic cerebrovascular disease is close to that of head and neck CTA, which is worthy of clinical promotion.
Objective To investigate the diagnostic value of transcranial Doppler ultrasound(TCD) combined with carotid ultrasound in ischemic cerebrovascular disease for clinical reference. Methods Total 739 patients with ischemic cerebrovascular disease in the department of neurology in our hospital were enrolled in the study, who were given TCD, carotid ultrasound and CT angiography(CTA) of head and neck within one week after admission, with the results as the reference for the final diagnosis. The positive rates of TCD combined with carotid ultrasonography and CTA were compared. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of combined examinations were calculated. Results ① There were no significant difference in the positive rate between TCD combined with carotid ultrasonography and CTA(49.53% vs. 51.69%, χ~2=0.693, P=0.405). ② The positive predictive rate of TCD combined with carotid ultrasound was 97.27%, the negative predictive rate was 93.03%, the sensitivity was 93.19%, the specificity was 97.20%, the accuracy was 95.13%, and the Kappa value was 0.903. Conclusion The diagnostic accuracy of TCD combined with carotid ultrasound for ischemic cerebrovascular disease is close to that of head and neck CTA, which is worthy of clinical promotion.
引文
[1] 邱笑琼,杨军,陆川,等.结合中医体质因素的缺血性脑血管病脑动脉狭窄危险因素分析[J].中华全科医学,2016,14(2):300-302.
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[3] 龙翠英,郑春玲,黄刚,等.数字减影血管造影下神经介入溶栓术治疗缺血性脑血管疾病的近期及远期疗效[J].中国实用神经疾病杂志,2017,20(1):34-37
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[6] 朱艳,张志斌,贺晓丹,等.颈动脉超声在心血管疾病高危人群中的评估作用[J].中国循证心血管医学杂志,2016,8(10):1246-1248.
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[9] 赵丽娟,肖春,孙广宏,等.彩色多普勒超声诊断缺血性脑血管病:与CTA、DSA对比分析[J].中国医学影像技术,2016,32(8):1189-1194.
[10] 冉青,郭琦.缺血性脑血管病患者颈动脉粥样硬化斑块表面形态的临床研究[J].中国实用神经疾病杂志,2016,19(8):105-106.
[11] HO S S.Current status of carotid ultrasound in atherosclerosis[J].Quant Imaging Med Surg,2016,6(3):285-296.
[12] 穆洁,勇强,刘凤菊,等.三维颈动脉超声在缺血性脑血管病中的应用[J].中国超声医学杂志,2015,31(1):1-4.
[13] 张恒,周盼妍,谢培凯,等.缺血性脑血管病患者颅内动脉狭窄TCCD、颈动脉超声联合诊断与CTA诊断的对比研究[J].中国医学创新,2018,15(8):14-18.
[14] 袁波,刘运海,谭莉,等.脑动脉狭窄的CTA、DSA对比研究临床意义[J].脑与神经疾病杂志,2016,24(4):229-232.
[15] HUIBERS A,DE BORST G J,THOMAS D J,et al.The Mechanism of Procedural Stroke Following Carotid Endarterectomy within the Asymptomatic Carotid Surgery Trial 1[J].Cerebrovasc Dis,2016,42(3-4):178-185.
[16] ROTSTEIN A H,GIBSON R N,KING P M.Direct B-mode NASCET-style stenosis measurement and Doppler ultrasound as parameters for assessment of internal carotid artery stenosis.[J].Australas Radiol,2015,46(1):52-56.
[17] 张艳.高血压患者的经颅多普勒超声检测结果分析[J].中华全科医学,2014,12(7):1125-1126.
[2] 武剑,赵璟妍,黄镪,等.中国缺血性脑血管病患者脑动脉狭窄分布与危险因素的荟萃分析[J].中华医学杂志,2015,95(29):2396-2402.
[3] 龙翠英,郑春玲,黄刚,等.数字减影血管造影下神经介入溶栓术治疗缺血性脑血管疾病的近期及远期疗效[J].中国实用神经疾病杂志,2017,20(1):34-37
[4]HERZIC R BU?VAL S,K?UPKA B,et al.Comparison of ultrasonography,CT angiography,and digital subtraction angiography in severe carotid stenoses[J].Eur J Neurol, 2015,11(11):774-781.
[5] 刘斌,王旭,张晋霞,等.256层螺旋CT机头颈部CTA检查对脑梗死患者脑血管狭窄的诊断价值[J].临床神经病学杂志,2015,28(1):31-33.
[6] 朱艳,张志斌,贺晓丹,等.颈动脉超声在心血管疾病高危人群中的评估作用[J].中国循证心血管医学杂志,2016,8(10):1246-1248.
[7] 华扬,高山,吴钢,等.经颅多普勒超声操作规范及诊断标准指南[J].中华医学超声杂志:电子版,2008, 5(2):197-222.
[8] 陈雪君,朱建平.彩色多普勒超声准确评估颈动脉狭窄的研究进展[J].中国动脉硬化杂志,2016,24(7):742-746.
[9] 赵丽娟,肖春,孙广宏,等.彩色多普勒超声诊断缺血性脑血管病:与CTA、DSA对比分析[J].中国医学影像技术,2016,32(8):1189-1194.
[10] 冉青,郭琦.缺血性脑血管病患者颈动脉粥样硬化斑块表面形态的临床研究[J].中国实用神经疾病杂志,2016,19(8):105-106.
[11] HO S S.Current status of carotid ultrasound in atherosclerosis[J].Quant Imaging Med Surg,2016,6(3):285-296.
[12] 穆洁,勇强,刘凤菊,等.三维颈动脉超声在缺血性脑血管病中的应用[J].中国超声医学杂志,2015,31(1):1-4.
[13] 张恒,周盼妍,谢培凯,等.缺血性脑血管病患者颅内动脉狭窄TCCD、颈动脉超声联合诊断与CTA诊断的对比研究[J].中国医学创新,2018,15(8):14-18.
[14] 袁波,刘运海,谭莉,等.脑动脉狭窄的CTA、DSA对比研究临床意义[J].脑与神经疾病杂志,2016,24(4):229-232.
[15] HUIBERS A,DE BORST G J,THOMAS D J,et al.The Mechanism of Procedural Stroke Following Carotid Endarterectomy within the Asymptomatic Carotid Surgery Trial 1[J].Cerebrovasc Dis,2016,42(3-4):178-185.
[16] ROTSTEIN A H,GIBSON R N,KING P M.Direct B-mode NASCET-style stenosis measurement and Doppler ultrasound as parameters for assessment of internal carotid artery stenosis.[J].Australas Radiol,2015,46(1):52-56.
[17] 张艳.高血压患者的经颅多普勒超声检测结果分析[J].中华全科医学,2014,12(7):1125-1126.