两种超声标准评估动静脉内瘘成熟的效能

目的:动静脉内瘘(AVF)术后6周用两种超声标准评估AVF成熟情况,以AVF临床成熟定义为金标准,判断两种超声标准的临床诊断效能。方法:2017年5月至2018年5月期间,符合纳入标准患者111例,术后6周评价AVF是否达到临床成熟,并进行彩超评估。两种不同的超声标准与临床成熟定义之间进行比较,评价其关联度、一致性、诊断灵敏度及特异度。进一步采用ROC曲线分析两种超声标准的诊断效能,同时随访临床成熟组患者的AVF初级通畅率。结果:111例患者,98例达到临床成熟定义,临床成熟组6个月、12个月初级通畅率为90.7%、71.3%。术后6周,临床成熟组及未成熟组的引流静脉内径(0.46±0.08 cm vs 0.31±0.06 cm,P=0.000)及肱动脉血流量(758.47±257.33 ml/min vs 365.92±107.35 ml/min,P=0.000)差异有统计学差异。与临床成熟定义相比较,术后6周两种超声标准均与临床定义有低度关联。其中超声标准2(肱动脉血流量>500 ml/min,引流静脉内径≥4 mm)灵敏度,约登指数及一致性kappa值均高于超声标准1(肱动脉血流量>500 ml/min,引流静脉内径≥5 mm)(67.34%vs42.86%,0.326vs 0.145,P<0.05)。标准2的ROC曲线下面积(AUC)高于标准1(0.837 vs 0.668,P=0.023)。结论:AVF术后6周超声肱动脉血流量>500 ml/min,引流静脉内径≥4 mm的标准更适合用于判断AVF成熟度。

Efficiency of two ultrasound standards in evaluating maturation of arteriovenous internal fistulas

Objective:To assess the diagnostic efficiency of Doppler ultrasound on arteriovenous fistula(AVF)maturation.And to determine which Doppler ultrasound criteria is more suitable for clinical application. Methodology:Between May 2017 and May 2018,111 patients with first time radial-cephalic AVF creation at wrist were enrolled in the study.Doppler ultrasound was performed before and at the 6 th week after AVF creation.Primary patency rates were assessed in clinical matured AVF.And then correlation,intra-observer agreement and diagnostic test between the two different Doppler ultrasound criteria and clinical AVF maturation criteria were tested.ROC was used to analyze the diagnostic efficiency of two Doppler ultrasound criteria. Results:Of the 111 enrolled patients,98 patients met clinical AVF maturation criteria at the 6 th week after AVF creation.Primary patency rates of the 98 clinical matured AVF were 90.7% and 71.3% at 6 and 12 month,respectively.At the 6 th week after AVF creation,there were significant differences on diameter of venous outflow track(0.46±0.08 cm vs 0.31±0.06 cm,P=0.000)and brachial arterial blood flow volume(758.47±257.33 ml/min vs 365.92±107.35 ml/min,P=0.000)between clinical matured group and immatured group.Either Doppler ultrasound criteria 1(inner diameter of the draining vein≥5 mm and natural blood flow≥500 ml/min),or criteria 2(inner diameter of draining vein≥4 mm and natural blood flow≥500 mL/min),had low correlation with clinical AVF maturation criteria.Compared with clinical AVF maturation criteria,the sensitivity,Youden index and kappa of ultrasound criteria 2 were better than that of criteria 1(67.34%vs 42.86%;0.326 vs 0.145,P<0.05).Furthermore,AUC of ultrasound criteria 2 was higher than that of criteria 1(0.837 vs 0.668,P=0.023). Conclusion:Six weeks after AVF surgery,inner diameter of draining vein≥4 mm and natural blood flow≥500 ml/min should be more suitable for judging the maturation of AVF.