小腿静脉功能超声分级的初步探讨  

Preliminary Study of the Ultrasonic Grading of Calf Veins Function

作　　者：熊建群[1] 王莉[1] 余琛[1] 张勤勤[1] 李应华[1] 

机构地区：[1]广州医科大学附属第二医院超声科,广州市510260

出　　处：《中国超声医学杂志》2014年第1期64-68,共5页Chinese Journal of Ultrasound in Medicine

基　　金：广东省科技厅科研资助项目(No.2011B031800391)

摘　　要：目的探讨超声对小腿静脉功能从正常至血栓形成进行分级的可行性。方法前瞻性将238例小腿静脉的超声图像,以小腿静脉内径、腔内回声、瓣膜回声、加压超声和挤压远段静脉后的变化等声像为分级标准,以超声APTS级与DVT级为超声阳性,血清D-dimer>500 ng/ml为临床阳性,进行一致性检验,绘制ROC曲线。结果小腿静脉从正常至血栓形成分为Normal级、EPTS级、APTS级与DVT级等4级。DVT级、APTS级分别与EPTS级、Normal级比较,D-dimer阳性率差异有统计学意义(P<0.01),DVT级与APTS级、EPTS级与Normal级之间的D dimer阳性率差异无统计学意义(P>0.05)。ROC曲线下面积为0.856,标准误0.04,小腿静脉超声图像4级诊断法的价值较高。结论超声可以对小腿静脉功能进行分级。超声4级法可为临床分级防治提供有价值的信息。Objective To study the feasibility of grading calf vein from normal to deep vein thrombosis by ultra- sonography. Methods A total of 238 in-patient subjects were enrolled in this prospective study. Ultrasound examina- tions were performed independently by two experienced sonographers with the same instrument and parameter setting. Following the standard, such as calf vein diameter, echo in vein cavity, echo of vein valve, the image changed after using compression uhrasonography or giving a pressure on distal segment vein, D-dimer^500 ng/ml was considered to be positive, and reliability of the grading diagnoses were analysed by Receiver Operating Characteristic （ROC） curves. Results All of the subjects were divided into four levels： Normal （normal）, early prethrombotic state （EPTS）, ad- vanced prethrombotic state （APTS）, deep venous thrombosis （DVT）,and so on. There was significantly difference in the D-dimer-positive rate between DVT and EPTS（P〈0.01）, and between APTS and EPTS （P^0.01）, and normal （P〈0.01）. The constituent ratio was same between the DVT and APTS, EPTS and Normal （P〉0.05, respective- ly）. Taking DVT and APTS for the ultrasound-positive, and D-dimer more than 500 ng/ml for the clinical-positive, there was a good consistency between the two methods （Kappa-test, K= 0. 682, P〈0.01）. The area under ROC curve is 0. 856. Conclusions The uhrasonograms of calf vein could be graded from normal to thrombosis, and valuable information is available by ultrasonography for the clinical classification prevention and treatment.

关 键 词：小腿 静脉 彩色多普勒超声 血栓前状态 血栓 

分 类 号：R445.1[医药卫生—影像医学与核医学]