彩色多普勒超声对动脉粥样硬化性肾动脉狭窄的诊断价值

目的评价彩色多普勒超声对动脉粥样硬化性肾动脉狭窄(ARAR)的诊断准确性,并确定其最有效的诊断方法。方法 86例ARAR患者,超声检测其172个肾脏形态学及172条肾动脉血流动力学指标:动脉狭窄处峰值血流速度(PSV)、肾动脉与腹主动脉峰值流速比值(RAR)及叶间动脉加速时间(AT);以肾动脉造影为标准,评价超声诊断ARAS的准确性。结果 172条肾动脉造影:肾动脉37条正常,36条狭窄60%,92条狭窄60%～95%,5条狭窄96%～99%,2条闭塞。超声诊断狭窄≥60%符合率为98.0%。对狭窄≥60%的病变,肾动脉PSV≥180 cm/s的敏感性95.9%,RAR≥3.0的敏感性56.7%,AT0.07 s的敏感性69.1%,肾脏长径的ROC曲线下面积为0.504。肾动脉狭窄96%～99%时,肾动脉PSV180 cm/s,而AT均0.07 s,患处血流较对侧明显变细。闭塞时,肾动脉主干内未见彩色血流信号,如肾内能显示动脉血流,AT0.07 s。结论对于诊断肾动脉狭窄60%～95%的ARAS,肾动脉PSV是最佳指标;对于高度狭窄及闭塞者,两侧动脉的彩色血流对比显示联合AT0.07 s,较单纯血流动力学指标更可靠。

Application value of color Doppler ultrasonograpy in diagnosing atherosclerosclerotic renal artery stenosis

Objective To evaluate the diagnostic accuracy of color Doppler ultrasound in atherosclerotic renal artery stenosis （ARAR） and determine the most effective method. Methods Total 172 renal arteries and kidneys of 86 patients with atherosclerotic diseases were examined by color Doppler ultrasonograpy and renal artery angiography. Peak systolic velocity（PSV）,the ratio of the renal artery to abdominal aorta（RAR） and intrarenal acceleration time（AT） were obtained. The accuracy of ultrasonic diagnosis for the above indexes was evaluated according to the results of renal artery angiography. Results The renal arteriography showed 92 cases of stenosis 60%~95%,5 of 96%~99%,36 of0.07 s were 95.9%,56.7%and 69.1%,respectively. The area under ROC curve of renal length was 0.504. In patients with stenosis 96%~99%, PSV0.07 s, and blood flow was significantly thinner than the contralateral. When the artery was occluded,no color blood flow signal appeared and AT was〉0.07 s. Conclusion PSV is the best diagnostic indicator for renal artery stenosis of 60%~95%, and for the the more severe stenosis,comparative analysis of both sides combined with AT〉0.07 s are more effective than the direct indicators of blood flow dynamics.