多模态超声评估尿毒症患者动静脉造瘘术前桡动脉弹性变化及病理对照研究  

Multimodal ultrasound in assessing elastic changes of radial arteries before arteriovenous fistula in uremic patients:A case-control study

作　　者：胡艳[1] 董磊 郭丽苹[1] 饶先刚 HU YanD;ONG Lei;GUO Liping;RAO Xian'gang(Department of Ultrasound,Zhongshan Hospital Affiliated to Dalian University,Dalian 116000,China;Department of Ultrasound,the 960th Hospital of PLA,Ji'nan 250031,China)

机构地区：[1]大连大学附属中山医院超声科,辽宁大连116000 [2]解放军第九六〇医院超声科,山东济南250031

出　　处：《中国现代医生》2020年第5期118-122,I0001,共6页China Modern Doctor

基　　金：辽宁省大连市医学卫生科学研究计划项目(1711098)。

摘　　要：目的探讨多模态超声评估尿毒症患者动静脉造瘘术前桡动脉弹性变化的临床应用价值。方法选取2017年1月~2018年8月于我院就诊的45例门诊体检者及经肾内科确诊的78例拟行动静脉瘘的尿毒症患者,根据桡动脉(RA)病理结果将病例组分为轻度病变组和中-重度病变组,对所有受检者桡动脉分别进行常规二维超声、超声弹性成像及血管回声跟踪技术检查,将所得结果进行对比分析,并将弹性参数PWVβ、Ep、β、AC、B/A与桡动脉病变程度作相关性分析,进一步绘制ROC曲线,计算曲线下面积(AUC)、临界值、灵敏度及特异度。结果①二维超声显示:除对照组与轻度病变组桡动脉内-中膜(IMT)比较,差异无统计学意义(P>0.05)外,其他组间的IMT比较差异均有统计学意义(P<0.05)。②超声弹性成像(UE)显示:各组间比较差异均有统计学意义(P<0.05)。③血管回声跟踪技术(ET)显示:除AI参数在各组间比较,差异均无统计学意义(P>0.05)外,其他参数在各组间比较,差异均有统计学意义(P<0.05)。④相关性分析:除AI参数外,PWVβ、Ep、β、AC、B/A弹性参数与桡动脉病变程度具有显著相关性(P<0.001),其中弹性参数PWVβ、Ep、β、B/A与桡动脉病变程度呈正相关(r=0.895、0.889、0.847、0.803);弹性参数AC与桡动脉病变程度呈负相关(r=-0.833)。⑤弹性参数PWVβ、Ep、β、AC、B/A值的曲线下面积分别为0.897、0.857、0.769、0.750、0.677。结论UE及ET技术较常规二维超声能客观、准确的评估拟行动静脉瘘尿毒症患者的桡动脉弹性变化,其中,ET技术的弹性参数PWVβ的灵敏度和特异度较好,是动静脉瘘术前评估桡动脉弹性变化的有价值指标。Objective To investigate the clinical value of multimodal ultrasound in assessing the elasticity of radial artery before arteriovenous fistula in patients with uremia.Methods 45 cases of outpatient physical examinees from Zhongshan Hospital Affiliated to Dalian University between January 2017 and August 2018 were selected as the control group,and 78 cases of uremic patients with arteriovenous fistula diagnosed by nephrology department from the same period were selected and were grouped into mild lesions and moderate-severe lesions groups according to the results of radial artery(RA)pathology.All subjects were examined with conventional two-dimensional ultrasound,elastography,and vascular echo tracking techniques.The results were compared and analyzed,and the correlation between elastic parameters PWVβ,Ep,β,AC,B/A and RA were analyzed.The ROC curve was further drawn to calculate the area under the curve(AUC),critical value,sensitivity and specificity.Results(1)Two-dimensional ultrasound showed that:except that there was no statistical difference in intima media thickness(IMT)of RA between the control group and the mild group(P>0.05),there was statistical difference in IMT of RA between the other groups(P<0.05).(2)Ultrasonic Elastography(UE)showed that the differences between groups were statistically significant(P<0.05).(3)Vascular echo tracking technology(ET)showed that except for AI parameters,the differences of other parameters were statistically significant between the groups(P<0.05).(4)Correlation analysis:except for AI parameters,elastic parameters such as PWVβ,Ep,β,AC,B/A were significantly correlated with the degree of RA lesions(P<0.001),among which the elastic parameters PWVβ,Ep,β,B/A were positively correlated with the degree of RA lesions(rs were 0.895,0.880,0.847,0.803);the elasticity parameter AC was negatively correlated with the degree of RA lesions(rs=-0.833).(5)The AUC of the elasticity parameters PWVβ, Ep, β, AC, B/A values were 0.897, 0.857, 0.769, 0.750, 0.677, respectively. Conclusion

关 键 词：血管回声跟踪技术 超声弹性成像技术 桡动脉 尿毒症 动静脉瘘 

分 类 号：R445.1[医药卫生—影像医学与核医学]