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目的:探讨彩色多普勒超声诊断老年动脉粥样硬化性肾动脉狭窄(ARAS)的血流动力学参数阈值。方法:应用多普勒超声检测259例老年ARAS患者(共462支)的肾动脉和叶间动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),叶间动脉的加速度(AC)、加速时间(AT),腹主动脉峰值流速,观察肾动脉及肾内叶间动脉血流分布,计算肾动脉与腹主动脉PSV比值(RAR)、肾动脉与叶间动脉PSV比值(RIR),以数字减影血管造影(DSA)检查结果为标准绘制受试者工作特征(ROC)曲线,分析诊断老年ARAS的血流动力学参数阈值,比较上述各参数在不同取值下的敏感性及特异性。结果:诊断≥70%狭窄的老年ARAS患者的最佳PSV、RAR、RIR阈值分别为:248.0cm/s、3.42、10.67,其诊断敏感性和特异性分别为94.4%和81.4%、91.2%和77.8%、93.9%和82.8%。结论:彩色多普勒超声对于老年ARAS患者的筛查诊断、狭窄程度的判断具有重要的临床价值。采用老年ARAS的指标阈值可以提高诊断准确性,对选择治疗方式有指导作用。
Objective: To investigate the threshold value of hemodynamic parameters in the diagnosis of senile atherosclerotic renal artery stenosis (ARAS) by color Doppler sonography. Methods: The peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), interlobar arteries of 259 elderly ARAS patients (total 462) were measured by Doppler sonography. (AC), acceleration time (AT), the peak velocity of abdominal aorta, the distribution of renal artery and interrenal artery blood flow, the ratio of renal artery to abdominal aorta PSV (RAR), renal artery and interlobar artery PSV Ratio (RIR). The receiver operating characteristic (ROC) curve was drawn based on the results of digital subtraction angiography (DSA), and the threshold of hemodynamic parameters in the diagnosis of elderly ARAS was analyzed. The above parameters were compared under different values Sensitivity and specificity. Results: The best PSV, RAR and RIR threshold were 248.0 cm / s, 3.42 and 10.67 in elderly patients with ARAS ≥ 70%, respectively. The diagnostic sensitivity and specificity were 94.4% and 81.4%, 91.2% and 77.8%, 93.9% and 82.8%. Conclusion: Color Doppler ultrasound in elderly patients with ARAS screening diagnosis, the degree of stenosis has important clinical value. The use of indicators of elderly ARAS threshold can improve diagnostic accuracy, guidance on the choice of treatment.