论文部分内容阅读
目的:探讨超声造影在肾动脉狭窄程度分级评估中的诊断价值。方法:以2018年1月至2021年7月在山西省人民医院就诊的86例可疑肾动脉狭窄患者为研究对象，可疑狭窄肾动脉共153条，其中左侧肾动脉72条，右侧肾动脉81条。对所有可疑狭窄肾动脉均行数字减影血管造影（DSA）、多普勒超声及超声造影检查，以DSA检查结果为诊断标准，分析多普勒超声、超声造影检查诊断肾动脉狭窄的灵敏度、特异度、准确度、阳性预测值和阴性预测值，以及与DSA诊断肾动脉狭窄程度的一致性。通过受试者工作特征（ROC）曲线下面积评估多普勒超声与超声造影对肾动脉狭窄程度诊断的准确度，并进行组间比较。结果:153条可疑狭窄肾动脉经DSA检查，其中52条（左侧23条，右侧29条）造影剂填充良好，101条狭窄≥30%（左侧49条，右侧52条），Ⅰ~Ⅳ级狭窄分别为31、45、20和5条。多普勒超声诊断肾动脉狭窄的灵敏度为74.3%（75/101），特异度为76.9%（40/52）；Ⅰ~Ⅳ级狭窄分别为21、42、20和4条。超声造影诊断肾动脉狭窄的灵敏度为88.1%（89/101），特异度为86.5%（45/52）；Ⅰ~Ⅳ级狭窄分别为26、43、23和4条。多普勒超声与DSA检查对肾动脉狭窄程度的分级诊断结果比较，差异有统计学意义（χn 2=4.447，n P=0.03），具有中等一致性（n Kappa=0.480）；超声造影与DSA检查对肾动脉狭窄程度的分级诊断结果比较，差异无统计学意义（χn 2=0.842，n P=0.36），具有较好一致性（n Kappa=0.730）。ROC曲线分析显示，超声造影诊断肾动脉狭窄的准确度优于多普勒超声，差异有统计学意义（n Z=4.361，n P<0.01）。n 结论:超声造影对肾动脉狭窄程度的诊断准确、有效，是肾动脉狭窄程度分级的可靠诊断方法。“,”Objective:To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in evaluating the severity of renal artery stenosis.Methods:Eighty six patients with suspected renal artery stenosis admitted to Shanxi Provincial People′s Hospital from January 2018 to July 2021 were enrolled in the study. All patients underwent digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and CEUS examinations. With DSA results as gold standard the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS and DUS in the diagnosis of renal artery stenosis were analyzed. The consistency between CEUS and DSA in the diagnosis of renal artery stenosis was evaluated. The accuracy of DUS and CEUS in diagnosis of renal artery stenosis was assessed by the area under receiver operating characteristic (ROC) curve (AUC) and compared between groups.Results:Among 153 renal arteries from 86 patients examined by DSA, 101 showed the stenosis ≥30% (49 left and 52 right renal arteries), and there were 31, 45, 20 and 5 renal arteries with grade I, II, III and IV stenosis. The sensitivity and specificity of DUS in the diagnosis of renal artery stenosis were 74.3% (75/101) and 76.9% (40/52),respectively. DUS showed 21, 42, 20 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. The sensitivity and specificity of CEUS in the diagnosis of renal artery stenosis were 88.1% (89/101) and 86.5%(45/52), respectively. CEUS showed 26, 43, 23 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. There was a significant difference between DUS and DSA in grading of renal artery stenosis (χ2=4.447, n P=0.03),and there was a moderate consistency between DUS and DSA (n Kappa=0.480). There was no significant difference between CEUS and DSA in grading renal artery stenosis (χ2=0.842, n P=0.36) with a good consistency (n Kappa=0.730). The AUC of CEUS in diagnosis of renal artery stenosis was higher than that of DUS [0.873 (95%n CI: 0.808-0.938) n vs. 0.756 (95%n CI:0.673-0.839); n Z=4.361, n P<0.01].n Conclusion:The study suggests that contrast-enhanced ultrasonography may be used as a diagnostic method for grading renal artery stenosis.