彩色多普勒超声评价肾动脉狭窄血流动力学参数间的比较研究

目的 应用受试者工作特征（ROC）曲线探讨不同血流动力学参数对内径减少≥60%肾动脉狭窄（RAS）的诊断价值.方法 采用彩色多普勒血流成像并经肾动脉数字血管减影（DSA）检查的110条肾动脉进行分析研究,测量并计算肾动脉峰值流速（PSV）、肾动脉主干与叶间动脉PSV比值（RIR）、肾动脉与腹主动脉PSV比值（RAR）、肾动脉内径（RAD）,以DSA检查结果为＂金标准＂,绘制各血流动力学参数诊断RAS（内径减少≥60%）的ROC曲线,并计算曲线下面积.比较联合参数对RAS（内径减少≥60%）诊断的准确性.结果 RIR、肾动脉主干PSV、RAR、RAD诊断RAS（内径减少≥60%）ROC曲线下面积分别为0.932、0.911、0.903、0.779.根据ROC曲线结果RIR＞5.9、肾动脉主干PSV＞177 cm/s、RAR＞2.8是诊断RAS（内径减少≥60%）的最好阈值,敏感性分别为87.3%、85.5%、82.5%,特异性分别为87.8%、90.5%、80.5% .采用肾动脉主干PSV＞177 cm/s联合RIR＞5.9或联合RAR＞2.8的敏感性相对提高分别为92.1%和90.3%,特异性分别为82.9%和85.7%.结论 ROC曲线结果显示不同血流动力学参数对RAS的诊断效力由高到低依次为RIR、肾动脉主干PSV、RAR、RAD,其中RIR、肾动脉PSV、RAR是较好的参数,RAD是相对较差的参数.联合参数诊断RAS较单一参数提高了诊断敏感性和阴性预测值,减少了漏诊和误诊率.

The comparative research on hemodynamics parameters of renal artery stenosis evaluated by color Doppler ultrasonography

Objective To evaluate the value of different hemodynamics parameters in diagnosis of renal artery stenosis （ diameter reduction ≥ 60% ） by receiver operating characteristic （ ROC ） curves. Method A total of 110 renal arteries performed by color Doppler flow imaging and digital subtraction angiography （DSA） were analyzed, meanwhile, the peak systolic velocity （PSV） , ratio of PSV in renal artery to that in interlobar artery, and aorta were measured and calculated. On the basis of DSA result which is regarded as the ＂golden standard＂, ROC curve diagnosing RAS （diameter reductions≥60% ） was performed, and areas under the curve were calculated. Results The results of ROC diagnosing RAS （ diameter reduction ≥ 60% ） by RIR, renal artery PSV,RAR,RAD showed the area under curves reached 0. 932, 0. 911, 0.903, 0. 779 respectively. The ROC results also showed that the best parameters diagnosing RAS （ diameter reductions≥60% ） were RIR 〉5.9, renal artery PSV 〉 177 cm/s, RAR 〉2.8, with the sensitivities of 87.3%, 85.5%, 82.5% ,and the specificities of 87.8% , 90.5% , 80.5%. The combination of renal artery PSV 〉 177 cm/s and RIR 〉5.9 or PSV 〉 177 cm/s and RAR 〉2.8 provided sensitivities of 92.1%, 90.3% and specificities of 82.9%, 85.7%. Conclusions The result of ROC curve indicates the effectiveness of different renal artery stenosis hemodynamics parameters in diagnosis of RAS, RIR 〉 renal artery PSV 〉 RAR 〉 RAD. The RIR, renal artery PSV and RAR are the best indicators while RAD is relatively the poor one. The combined parameters diagnosing RAS improves the sensitivity and the negative predicted more values than singular parameter, which will help to reduce rates of misdiagnosis.