超声造影评估大动脉炎性肾动脉狭窄的临床诊断价值  

Clinical diagnostic value of contrast-enhanced ultrasonography in evaluating takayasu’s arteritis-induced renal artery stenosis

作　　者：刘志文[1] 马娜[1] 王思宇[1] 孙由静[1] 刁永鹏[2] 陈作观 李拥军[2] 任俊红[1] Liu Zhiwen;Ma Na;Wang Siyu;Sun Youjing;Diao Yongpeng;Chen Zuoguan;Li Yongjun;Ren Junhong(Department of Ultrasonography,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Vascular Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院超声科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院血管外科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中国心血管杂志》2023年第4期367-372,共6页Chinese Journal of Cardiovascular Medicine

基　　金：中央高水平医院临床科研业务费(BJ-2018-198);北京市科学技术委员会、中关村科技园区管理委员会项目(Z211100002921011);中国医学科学院中央级公益性科研院所基本科研业务费项目(2019PT320012)。

摘　　要：目的比较超声造影(CEUS)评估大动脉炎性肾动脉狭窄(TARAS)与临床狭窄程度的一致性及相关性。方法回顾性分析北京医院2018年6月至2022年8月期间19例未经外科介入治疗的TARAS患者,以分肾为研究对象,利用肾动脉超声造影检查对其中36支肾动脉进行狭窄程度评估,临床狭窄程度评估采用数字减影血管造影等证实。上述影像学方法均根据RAS狭窄程度分为轻度(30%~49%)、中度(50%~69%)和重度(70%~99%),分析CEUS对轻、中和重度RAS的诊断与临床狭窄程度的诊断一致性及相关性。结果19例(36支肾动脉)疑似TARAS患者中男性5例(26.3%),女性14例(73.7%),年龄10~34岁,平均为(22.2±7.6)岁。CEUS诊断结果:无狭窄6支(16.7%),轻度狭窄1支(2.8%),中度狭窄5支(13.9%),重度狭窄12支(33.3%),闭塞12支(33.3%);临床诊断结果:无狭窄6支(16.7%),无轻度狭窄,中度狭窄3支(8.3%),重度狭窄13支(36.1%),闭塞14支(38.9%)。CEUS诊断TARAS和临床诊断结果有较高的一致性(kappa=0.81,P<0.01),狭窄度相关性(Kendall’stau-b相关系数=0.90,P<0.01)和狭窄率相关性(Spearman相关系数=0.91,P<0.01)均较高。结论CEUS诊断TARAS与临床诊断结果有较高的一致性和相关性,具有较好的应用前景。Objective To compare the consistency and correlation between contrast-enhanced ultrasonography(CEUS)assessment of takayasu’s arteritis-induced renal artery stenosis(TARAS)and clinical stenosis.Methods From June 2018 to August 2022,19 patients with suspected TARAS who were diagnosed and not underwent surgical intervention in Beijing Hospital were retrospectively analyzed.The stenosis degree of 36 renal arteries was evaluated by CEUS,and the clinical stenosis degree was evaluated by digital subtraction angiography(DSA).RAS were divided into mild stenosis(30%-49%),moderate stenosis(50%-69%)and severe stenosis(70%-99%)according to the degree of luminal stenosis.Concordance and correlation of clinical stenosis and CEUS evaluation was analyzed.Results Among the 19 patients(36 renal arteries)with suspected TARAS,5 cases were male(26.3%)and 14 cases(73.7%)were female.The average age was(22.2±7.6)years with a range of 10-34 years.CEUS diagnostic results showed no stenosis in 6 vessels(16.7%),mild stenosis in 1 vessel(2.8%),moderate stenosis in 5 vessels(13.9%),severe stenosis in 12 vessels(33.3%),and occlusion in 12 vessels(33.3%).Clinical diagnostic result showed no stenosis in 6 vessels(16.7%),none with mild stenosis,3 vessels with moderate stenosis(8.3%),13 vessels(36.1%)with severe stenosis,and 14 vessels(38.9%)with occlusion.CEUS diagnosis was strongly correlated with clinical diagnosis,with high concordance(kappa=0.81,P<0.01),RAS degree’correlation(Kendall’stau-b=0.90,P<0.01)and luminal stenosis’correlation(Spearman coefficient=0.91,P<0.01).Conclusions CEUS diagnosis of TARAS has a high consistency and correlation with clinical diagnosis results,and has a high application prospect.

关 键 词：大动脉炎 肾动脉狭窄 超声造影 诊断价值 

分 类 号：R543.5[医药卫生—心血管疾病]