摘要
目的探讨彩色多普勒超声对下肢动脉支架内再狭窄(ISR)的诊断价值,为临床应用提供依据。方法选取下肢动脉支架植入术后12个月内,经CT血管造影(CTA)或数字减影血管造影(DSA)证实的再狭窄患者31例(植入支架再狭窄47处)、未狭窄患者63例(植入支架89处)及健康对照者30名行超声检查,获取支架内、支架近心端及远心端自体血管的二维超声声像图特点及收缩期峰值血流速度(PSV)、收缩期血流加速时间(AT),与健康对照者相应血管血流参数作比较。应用受试者操作特性(ROC)曲线分析PSV、AT对下肢动脉ISR的诊断价值。结果未狭窄组股总动脉、股浅动脉、腘动脉支架内PSV分别为(146.71±35.59)、(120.11±25.67)、(96.44±32.87)cm/s,健康对照组上述指标分别为(119.67±15.34)、(91.17±15.09)、(71.13±21.23)cm/s,组间比较,差异均有统计学意义(t=2.457、2.459、2.321,P均<0.05);未狭窄组股总动脉、股浅动脉、腘动脉AT分别为(84.98±13.77)、(87.33±16.36)、(90.77±12.05)ms;健康对照组上述指标分别为(78.23±21.24)、(82.31±18.24)、(84.29±23.01)ms,组间比较,差异均无统计学意义(t=1.696、1.904、1.835,P均>0.05)。再狭窄组支架近心端、狭窄处、远心端PSV分别为(87.67±23.34)、(218.17±72.09)、(54.13±21.23)cm/s,未狭窄组支架近心端、支架内、远心端PSV分别为(91.71±25.59)、(131.11±45.67)、(96.44±32.87)cm/s,组间比较,支架内/狭窄处及支架远心端PSV的差异有统计学意义(t=3.412、3.511,P均<0.01),支架近心端PSV差异无统计学意义(t=1.901,P>0.05);再狭窄组支架近心端、狭窄处、远心端AT分别为(98.31±14.09)、(109.54±21.03)、(158.23±45.21)ms,未狭窄组支架近心端、支架内、远心端AT分别为(84.98±13.77)、(86.34±19.36)、(83.77±17.05)ms,组间比较,支架内/狭窄处及支架远心端AT的差异有统计学意义(t=2.319、3.610,P均<0.05),支架近心端AT的差异无统计学意义(t=1.833,P>0.05)。ROC曲线显示,当下肢动脉出现ISR时,PSV>168 cm/s,敏感度为89.4%,特异度为92.1%,ROC曲线下面积为0.949;AT>127 ms,敏感度为86.8%,特异度为98.0%,ROC曲线下面积为0.867。结论彩色多普勒超声可发现下肢动脉ISR患者PSV及AT的改变,有助于明确诊断下肢动脉ISR;联合PSV>168 cm/s及AT>127 ms时诊断价值更高。
Objective To investigate the value of color Doppler flow imaging（CDFI） in diagnosing lower limb artery in-stent restenosis（ISR）, and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography（CTA） or digital subtraction angiography（DSA） was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity（PSV）, systolic blood flow acceleration time（AT） of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator（ROC） curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were（146.71±35.59） cm/s,（120.11±25.67） cm/s,（96.44±32.87） cm/s. PSV of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were（119.67±15.34） cm/s,（91.17±15.09） cm/s,（71.13±21.23） cm/s. There was statistically significant difference between the two groups（t=2.457, 2.459, 2.321, all P〈0.05）. AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were（84.98±13.77） ms,（87.33±16.36） ms,（90.77±12.05） ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were（78.23±21.24） ms,（82.31±18.24） ms,（84.29±23.01） ms. There was no statistically significant difference between the two groups（t=1.696, 1.904, 1.835, all P〉0.05）. PSV of restenosis group in proximal part, restenosis part, distal part respectively were（87.67±23.34） cm/s,（218.17±72.09） cm/s,（54.13±21.23） cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were（91.71±25.59） cm/s,（131.11±45.67） cm/s,（96.44±32.87） cm/s. There was statistically significant difference between restenosis part/inner stents, distal part（t=3.412, 3.511, both P〈0.05）. There was no statistically significant difference between the two groups in proximal part（t=1.901, P〉0.05）. AT of restenosis group in proximal part, restenosis part, distal part respectively were（98.31±14.09） ms,（109.54±21.03） ms,（158.23±45.21） ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were（84.98±13.77） ms,（86.34±19.36） ms,（83.77±17.05） ms. There was statistically significant difference between restenosis part/inner stents, distal part（t=2.319, 3.610, both P〈0.05）. There was no statistically significant difference between the two groups in proximal part（t=1.833, P〉0.05）. ROC curve showed that in ISR lower limb artery, PSV〉 168 cm/s had a sensitivity of 89.4%, specificity of 92.1%, the area under the ROC curve was 0.949; AT 〉127 ms, had a sensitivity of 86.8%, specificity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV 〉168 cm/s with AT 〉127 ms, the value of ISR diagnosis can be increased.
出处
《中华医学超声杂志（电子版）》
2014年第9期19-23,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
下肢动脉
支架内再狭窄
超声检查
Lower limb artery
Stent restenosis
Ultrasoundgraphy
