中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2014年
9期
710-714
,共5页
宋世晶%李慧展%杨青梅%康晓妍%姚浮成%薛继平%吕虹%康春松
宋世晶%李慧展%楊青梅%康曉妍%姚浮成%薛繼平%呂虹%康春鬆
송세정%리혜전%양청매%강효연%요부성%설계평%려홍%강춘송
下肢动脉%支架内再狭窄%超声检查
下肢動脈%支架內再狹窄%超聲檢查
하지동맥%지가내재협착%초성검사
Lower limb artery%Stent restenosis%Ultrasoundgraphy
目的探讨彩色多普勒超声对下肢动脉支架内再狭窄（ISR）的诊断价值，为临床应用提供依据。方法选取下肢动脉支架植入术后12个月内，经CT血管造影（CTA）或数字减影血管造影（DSA）证实的再狭窄患者31例（植入支架再狭窄47处）、未狭窄患者63例（植入支架89处）及健康对照者30名行超声检查，获取支架内、支架近心端及远心端自体血管的二维超声声像图特点及收缩期峰值血流速度（PSV）、收缩期血流加速时间（AT），与健康对照者相应血管血流参数作比较。应用受试者操作特性（ROC）曲线分析PSV、AT对下肢动脉ISR的诊断价值。结果未狭窄组股总动脉、股浅动脉、腘动脉支架内PSV分别为（146.71±35.59）、（120.11±25.67）、（96.44±32.87）cm/s，健康对照组上述指标分别为（119.67±15.34）、（91.17±15.09）、（71.13±21.23）cm/s，组间比较，差异均有统计学意义（t=2.457、2.459、2.321，P均＜0.05）；未狭窄组股总动脉、股浅动脉、腘动脉AT分别为（84.98±13.77）、（87.33±16.36）、（90.77±12.05）ms；健康对照组上述指标分别为（78.23±21.24）、（82.31±18.24）、（84.29±23.01）ms，组间比较，差异均无统计学意义（t=1.696、1.904、1.835，P均＞0.05）。再狭窄组支架近心端、狭窄处、远心端PSV分别为（87.67±23.34）、（218.17±72.09）、（54.13±21.23）cm/s，未狭窄组支架近心端、支架内、远心端PSV分别为（91.71±25.59）、（131.11±45.67）、（96.44±32.87）cm/s，组间比较，支架内/狭窄处及支架远心端PSV的差异有统计学意义（t=3.412、3.511， P均＜0.01），支架近心端PSV差异无统计学意义（t=1.901，P＞0.05）；再狭窄组支架近心端、狭窄处、远心端AT分别为（98.31±14.09）、（109.54±21.03）、（158.23±45.21）ms，未狭窄组支架近心端、支架内、远心端AT分别为（84.98±13.77）、（86.34±19.36）、（83.77±17.05）ms，组间比较，支架内/狭窄处及支架远心端AT的差异有统计学意义（t=2.319、3.610，P均＜0.05），支架近心端AT的差异无统计学意义（t=1.833，P＞0.05）。ROC曲线显示，当下肢动脉出现ISR时，PSV＞168 cm/s，敏感度为89.4%，特异度为92.1%，ROC曲线下面积为0.949；AT＞127 ms，敏感度为86.8%，特异度为98.0%，ROC曲线下面积为0.867。结论彩色多普勒超声可发现下肢动脉ISR患者PSV及AT的改变，有助于明确诊断下肢动脉ISR；联合PSV＞168 cm/s及AT＞127 ms时诊断价值更高。
目的探討綵色多普勒超聲對下肢動脈支架內再狹窄（ISR）的診斷價值，為臨床應用提供依據。方法選取下肢動脈支架植入術後12箇月內，經CT血管造影（CTA）或數字減影血管造影（DSA）證實的再狹窄患者31例（植入支架再狹窄47處）、未狹窄患者63例（植入支架89處）及健康對照者30名行超聲檢查，穫取支架內、支架近心耑及遠心耑自體血管的二維超聲聲像圖特點及收縮期峰值血流速度（PSV）、收縮期血流加速時間（AT），與健康對照者相應血管血流參數作比較。應用受試者操作特性（ROC）麯線分析PSV、AT對下肢動脈ISR的診斷價值。結果未狹窄組股總動脈、股淺動脈、腘動脈支架內PSV分彆為（146.71±35.59）、（120.11±25.67）、（96.44±32.87）cm/s，健康對照組上述指標分彆為（119.67±15.34）、（91.17±15.09）、（71.13±21.23）cm/s，組間比較，差異均有統計學意義（t=2.457、2.459、2.321，P均＜0.05）；未狹窄組股總動脈、股淺動脈、腘動脈AT分彆為（84.98±13.77）、（87.33±16.36）、（90.77±12.05）ms；健康對照組上述指標分彆為（78.23±21.24）、（82.31±18.24）、（84.29±23.01）ms，組間比較，差異均無統計學意義（t=1.696、1.904、1.835，P均＞0.05）。再狹窄組支架近心耑、狹窄處、遠心耑PSV分彆為（87.67±23.34）、（218.17±72.09）、（54.13±21.23）cm/s，未狹窄組支架近心耑、支架內、遠心耑PSV分彆為（91.71±25.59）、（131.11±45.67）、（96.44±32.87）cm/s，組間比較，支架內/狹窄處及支架遠心耑PSV的差異有統計學意義（t=3.412、3.511， P均＜0.01），支架近心耑PSV差異無統計學意義（t=1.901，P＞0.05）；再狹窄組支架近心耑、狹窄處、遠心耑AT分彆為（98.31±14.09）、（109.54±21.03）、（158.23±45.21）ms，未狹窄組支架近心耑、支架內、遠心耑AT分彆為（84.98±13.77）、（86.34±19.36）、（83.77±17.05）ms，組間比較，支架內/狹窄處及支架遠心耑AT的差異有統計學意義（t=2.319、3.610，P均＜0.05），支架近心耑AT的差異無統計學意義（t=1.833，P＞0.05）。ROC麯線顯示，噹下肢動脈齣現ISR時，PSV＞168 cm/s，敏感度為89.4%，特異度為92.1%，ROC麯線下麵積為0.949；AT＞127 ms，敏感度為86.8%，特異度為98.0%，ROC麯線下麵積為0.867。結論綵色多普勒超聲可髮現下肢動脈ISR患者PSV及AT的改變，有助于明確診斷下肢動脈ISR；聯閤PSV＞168 cm/s及AT＞127 ms時診斷價值更高。
목적탐토채색다보륵초성대하지동맥지가내재협착（ISR）적진단개치，위림상응용제공의거。방법선취하지동맥지가식입술후12개월내，경CT혈관조영（CTA）혹수자감영혈관조영（DSA）증실적재협착환자31례（식입지가재협착47처）、미협착환자63례（식입지가89처）급건강대조자30명행초성검사，획취지가내、지가근심단급원심단자체혈관적이유초성성상도특점급수축기봉치혈류속도（PSV）、수축기혈류가속시간（AT），여건강대조자상응혈관혈류삼수작비교。응용수시자조작특성（ROC）곡선분석PSV、AT대하지동맥ISR적진단개치。결과미협착조고총동맥、고천동맥、객동맥지가내PSV분별위（146.71±35.59）、（120.11±25.67）、（96.44±32.87）cm/s，건강대조조상술지표분별위（119.67±15.34）、（91.17±15.09）、（71.13±21.23）cm/s，조간비교，차이균유통계학의의（t=2.457、2.459、2.321，P균＜0.05）；미협착조고총동맥、고천동맥、객동맥AT분별위（84.98±13.77）、（87.33±16.36）、（90.77±12.05）ms；건강대조조상술지표분별위（78.23±21.24）、（82.31±18.24）、（84.29±23.01）ms，조간비교，차이균무통계학의의（t=1.696、1.904、1.835，P균＞0.05）。재협착조지가근심단、협착처、원심단PSV분별위（87.67±23.34）、（218.17±72.09）、（54.13±21.23）cm/s，미협착조지가근심단、지가내、원심단PSV분별위（91.71±25.59）、（131.11±45.67）、（96.44±32.87）cm/s，조간비교，지가내/협착처급지가원심단PSV적차이유통계학의의（t=3.412、3.511， P균＜0.01），지가근심단PSV차이무통계학의의（t=1.901，P＞0.05）；재협착조지가근심단、협착처、원심단AT분별위（98.31±14.09）、（109.54±21.03）、（158.23±45.21）ms，미협착조지가근심단、지가내、원심단AT분별위（84.98±13.77）、（86.34±19.36）、（83.77±17.05）ms，조간비교，지가내/협착처급지가원심단AT적차이유통계학의의（t=2.319、3.610，P균＜0.05），지가근심단AT적차이무통계학의의（t=1.833，P＞0.05）。ROC곡선현시，당하지동맥출현ISR시，PSV＞168 cm/s，민감도위89.4%，특이도위92.1%，ROC곡선하면적위0.949；AT＞127 ms，민감도위86.8%，특이도위98.0%，ROC곡선하면적위0.867。결론채색다보륵초성가발현하지동맥ISR환자PSV급AT적개변，유조우명학진단하지동맥ISR；연합PSV＞168 cm/s급AT＞127 ms시진단개치경고。
Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P<0.05). AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were (84.98±13.77) ms, (87.33±16.36) ms, (90.77±12.05) ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were (78.23±21.24) ms, (82.31±18.24) ms, (84.29±23.01) ms. There was no statistically signiifcant difference between the two groups (t=1.696, 1.904, 1.835, all P>0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.901, P>0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.833, P>0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.
