超声检查对胡桃夹现象的诊断价值  

Value of Ultrasonography in the Diagnosis of Nutcracker Phenomenon

作　　者：蒋清凌 覃斯 胡美玉 刘广健[1] Jiang Qingling;Qin Si;Hu Meiyu;Liu Guangjian(Department of Medical Ultrasound,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Medical Imaging,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院超声医学科,广州市510655 [2]中山大学附属第六医院医学影像科,广州市510655

出　　处：《中国超声医学杂志》2023年第1期49-52,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 筛选二维超声及多普勒超声诊断胡桃夹现象(NCP)的指标,并比较单一指标及联合指标对NCP的诊断价值。方法 回顾性分析行左肾静脉超声检查的患者82例。以对比增强计算机断层扫描(CECT)作为诊断金标准,采用受试者工作特征(ROC)曲线分析并获得二维超声及多普勒超声的诊断指标,比较单一指标及联合指标诊断NCP的诊断价值。结果 二维超声及多普勒超声诊断NCP的指标分别为:腹主动脉与肠系膜上动脉之间夹角(AMA)≤18°、左肾静脉扩张段内径(D_(2))/AMA内左肾静脉受压段内径(D_(1))>2.9、AMA内左肾静脉受压段血流速度(V_(1))/左肾静脉扩张段的血流速度(V_(2))>3.6。AMA≤18°、D_(2)/D_(1)>2.9、V_(1)/V_(2)>3.6单一指标及3项指标中满足任意两项或以上诊断NCP的灵敏度分别为:80%、90.9%、87.3%和94.5%,特异度分别为:51.9%、63%、63%和74.1%,准确度分别为:70.7%、81.7%、79.3%和87.8%,AUC分别为0.659、0.769、0.751和0.843。结论 AMA≤18°、D_(2)/D_(1)>2.9及V_(1)/V_(2)>3.6 3项指标中满足任意两项或以上诊断NCP价值优于单独任意一项指标,推荐作为筛查NCP的诊断方法广泛应用于临床。Objective To screen the indexes of two-dimensional ultrasound and Doppler ultrasound in the diagnosis of nutcracker phenomenon(NCP),and to compare the diagnostic value of single index and combined index in NCP.Methods 82 patients who underwent left renal vein ultrasonography in our hospital were analyzed retrospectively.Contrast enhanced computed tomography was served as gold standard,the diagnostic indexes of two-dimensional ultrasound and Doppler ultrasound were analyzed and obtained by receiver operating characteristic curve,and the diagnostic value of single index and combined index in the diagnosis of NCP was compared.Results The diagnostic indexes of NCP by two-dimensional ultrasound were as follows:the angle between abdominal aorta and superior mesenteric artery(AMA) ≤18°,the internal diameter of dilated segment of left renal vein(D_(2))/the internal diameter of compressed segment of left renal vein in the angle between abdominal aorta and superior mesenteric artery(D_(1)) >2.9.The diagnostic index of NCP by Doppler ultrasound was as follows:the blood flow velocity of the compressed segment of the left renal vein in the angle between abdominal aorta and superior mesenteric artery(V_(1))/the blood flow velocity of the dilated segment of the left renal vein(V_(2))>3.6.The sensitivity of AMA≤18°,D_(2)/D_(1)>2.9,V_(1)/V_(2)>3.6 and satisfy any two or more of the three indexes in the diagnosis of NCP were 80%,90.9%,87.3% and 94.5%,respectively,the specificity were 51.9%,63%,63% and 74.1%,and the accuracy were 70.7%,81.7%,79.3% and 87.8%,respectively.The area under the curve were 0.659,0.769,0.751 and 0.843,respectively.Conclusions With AMA≤18°,D_(2)/D_(1)>2.9 and V_(1)/V_(2)>3.6,the diagnostic value of any two or more of the three indexes in NCP is better than any single index alone.It is recommended to be widely used in clinic as a diagnostic method for screening NCP.

关 键 词：胡桃夹现象 超声 指标 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]