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目的探讨内径狭窄≥50%肾动脉狭窄(RAS)的直接超声参数特点及其诊断价值。方法经彩色多普勒血流成像(CDFI)检查后并接受肾动脉造影的89例患者共177条肾动脉构成研究组,测量了肾动脉峰值流速(RPSV)、肾动脉与腹主动脉峰值流速比值(RAR)、肾动脉与肾动脉峰值流速比值(RRR)、肾动脉与段动脉峰值流速比值(RSR)和肾动脉与叶间动脉峰值流速比值(RIR)。肾动脉造影显示肾动脉内径狭窄≥50%者确定为RAS。使用ROC曲线分析确定最佳诊断指标。计算这些流速指标不同阈值的敏感性、特异性、阳性预测值、阴性预测值和准确率。结果在肾动脉造影显示的177条肾动脉中,80条狭窄程度为50%～99%,7条闭塞。在狭窄程度50%～99%的80条肾动脉中,动脉粥样硬化性RAS46条,大动脉炎RAS20条,纤维肌性发育不良性RAS12条,其他病因2条。肾动脉CDFI检查成功率为98.9%(175/177)。RPSV、RAR、RRR、RSR、RIR最佳阈值分别为170cm/s、2.3、2.0、3.8、5.5。RPSV、RSR和RIR均获得较好的诊断效果(准确率均大于87%),RAR和RRR的诊断敏感性较差(分别为79%和80%)。结论对于狭窄≥50%的RAS,RPSV、RIR和RSR均是较好的诊断指标,RAR和RRR的诊断敏感性较差。影响肾动脉和腹主动脉PSV的因素都可导致RAR的诊断准确性下降,而PSV后比参数受腹主动脉PSV的影响较小,且各种原因所致肾动脉主干、肾内动脉PSV等成比例改变对PSV后比参数的影响也较小,其能明显弥补RAR的一些不足。
Objective To investigate the characteristics and diagnostic value of direct ultrasound parameters of stenosis ≥50% renal artery stenosis (RAS). METHODS: A total of 177 renal arteries of 89 patients who underwent renal artery angiography after color Doppler flow imaging (CDFI) examination were included in this study. RPSV, peak velocity of renal artery and abdominal aorta RAR, RRR, RSR and RIR of the renal artery to the interlobar artery. Renal angiography showed renal artery stenosis ≥ 50% were identified as RAS. Use ROC curve analysis to determine the best diagnostic indicator. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of these thresholds were calculated. Results In renal artery angiography showed 177 renal artery, 80 stenosis was 50% to 99%, 7 occlusion. In 80 renal arteries with stenosis of 50% -99%, atherosclerotic RAS46, aortic arteritis RAS20, fibromuscular dysplasia RAS12, and other causes of 2. The success rate of renal artery CDFI was 98.9% (175/177). The best threshold of RPSV, RAR, RRR, RSR and RIR were 170cm / s, 2.3,2.0,3.8,5.5 respectively. RPSV, RSR and RIR achieved better diagnostic results (accuracy rate greater than 87%), RAR and RRR poor diagnostic sensitivity (79% and 80%, respectively). Conclusion RAS, RPS, RIR and RSR are all good diagnostic criteria for RAS ≥50%. The diagnostic sensitivity of RAR and RRR is poor. Factors affecting the renal artery and abdominal aorta PSV can lead to the diagnosis of RAR decreased accuracy, and PSV after the parameters than the abdominal aorta PSV less affected, and a variety of causes of renal artery, renal artery PSV, etc. Proportional changes in PSV after the parameters than the impact is small, it can significantly make up for some deficiencies of RAR.