彩色多普勒超声对老年动脉粥样硬化性肾动脉狭窄患者的诊断价值

目的探讨彩色多普勒超声对老年动脉粥样硬化性肾动脉狭窄(ARAS)患者的诊断价值。方法选择ARAS患者60例(89支)作为ARAS组,其中39例行肾动脉造影,选择肾功能正常患者60例(107支)作为对照组,二维超声观察肾脏大小,彩色多普勒血流显像(CDFI)观察肾动脉血流形态,多普勒血流频谱观察肾叶间动脉收缩期峰值流速(PSV)、舒张末期流速、阻力指数、搏动指数、加速度、加速时间、肾动脉PSV、肾动脉与腹主动脉PSV比率(RAR)、肾动脉与叶间动脉PSV比率(RIR)。结果 ARAS组肾脏长径、宽径、厚径、实质厚度和实质/肾窦较对照组明显缩小(P0.01)。ARAS组39例(60支)患者肾动脉造影与经CDFI诊断的κ系数为0.688(P0.01),诊断一致性较好。对重度肾动脉狭窄患者,PSV21 6.5 cm/s、RAR3.1、RIR10.2的敏感性和特异性分别为100%和71.4%、75.0%和71.4%、73.1%和71.4%。结论彩色多普勒超声对于老年ARAS患者筛查诊断、狭窄程度判断和是否选择介入治疗具有重要临床价值。

Value of color Doppler ultrasonography for diagnosing atherosclerotic renal artery stenosis in the elderly patients

Objective To evaluate the value of color Doppler ultrasonography for diagnosing the atherosclerotic renal artery stenosis(ARAS) in old patients.Methods Sixty patients(89 renal arteries) diagnosed as ARAS(ARAS group) and 39 of them underwent renal artery angiography, other 60 cases(107 renal arteries) with normal renal arteries served as controls.Color Doppler flow image(CDFI) was used to observe the peak systolic velocity(PSV),the end diastolic velocity, resistive index,pulsation index,acceleration and acceleration time in the renal interlobar artery, PSV in the renal artery and RAR(the ratio of the PSV in the renal artery to that in the aorta), the ratio of the PSV in the renal artery to that in the interlobar artery(RIR).Results The size, thickness of parenchyma and the ratio of the parenchyma to the antrum of the kidneys in ARAS group were significantly decreased compared with those in controls (P< 0.01).In 39 cases(60 renal arteries) of ARAS group undergoing renal artery angiography and CDFI,the kappa coefficient was 0.688 (P< 0.01),which showed good agreement of same stenosis in renal arteries diagnosed by two diagnosis techniques.For patients with renal artery stenosis ≥70%,when the cutoff values of renal artery PSV>216.5 cm/s,RAR>3.1 and RIR>10.2 were used for the detection of ARAS,the sensitivity and specificity were 100% and 71.4%,75.0% and 71.4%,73.1% and 71.4% respectively.Conclusion Color Doppler ultrasonography has important clinical value in screening diagnosis,estimating the stenosis degree and choosing interventional treatment for the old patients with renal artery stenosis.