彩超在评估自体动静脉内瘘狭窄、血栓生成情况中的应用价值分析

doi:10.16150/j.1671-2870.2019.03.022

摘要/Abstract

摘要：

目的： 分析应用彩色超声（彩超）检查评估自体动静脉内瘘（autogenous arteriovenous fistula,AVF）狭窄、血栓生成情况的价值。方法： 回顾性分析86例疑似发生AVF狭窄或血栓生成的患者,根据血管造影检查结果将其分为大致正常组（20例）、单纯狭窄组（38例）和血栓形成组（28例）,比较3组患者的常规彩超检查情况（如桡动脉和头静脉内径、流速比值、狭窄程度、有无血栓以及血流量）,以血管造影结果作为金标准,评价彩超检查诊断AVF狭窄和血栓形成的效能。结果： 与大致正常组相比,单纯狭窄组及血栓形成组的瘘口内径、头静脉内径及血流量明显降低,流速比值和狭窄程度显著增高,差异均有统计学意义（P<0.05）。受试者工作特征（receiver operating characteristic curve,ROC）曲线显示,应用血流量诊断AVF狭窄的曲线下面积（area under curve,AUC）最高（0.964）,其次为流速比（AUC=0.903）和狭窄程度（AUC=0.823）,头静脉内径（AUC=0.708）和瘘口内径（AUC=0.697）的AUC最小。应用血流量（<482.62 mL/min）预测AVF狭窄的诊断准确率、灵敏度、特异度、阳性预测值和阴性预测值均显著高于其他指标（P<0.05）。彩超检查诊断AVF血栓形成的诊断效能与血管造影相似（Kappa=0.931,P<0.001）。结论： 应用彩超检查评估AVF狭窄及血栓生成情况,具有较高的临床价值,其中血流量（<482.62 mL/min）预测AVF狭窄的诊断效能较好。

关键词: 自体动静脉内瘘, 狭窄, 血栓形成, 超声多普勒

Abstract:

Objective: To evaluate the value of color Doppler ultrasonography in evaluation of stenosis and thrombosis of autogenous arteriovenous fistula. Methods: Eighty six patients with suspected stenosis or thrombosis of autologous arteriovenous fistula in the dialysis center of our hospital from January 2015 to October 2017 were analyzed retrospectively. According to angiographic examination, patients were categorized into roughly normal group (20 cases), stenosis group (38 cases) and thrombosis group (28 cases). Results of color Doppler ultrasound examination (internal diameter of radial artery and cephalic vein, flow velocity ratio, degree of stenosis, presence or absence of thrombus and blood flow) were compared among the three groups. Results of angiography were used as the gold standard to evaluate the efficacy of color Doppler ultrasound examination for diagnosing fistula stenosis and thrombosis. Results: Compared with the roughly normal group, fistula diameter, cephalic vein diameter and blood flow were decreased in stenosis group and thrombosis group, while flow velocity ratio and degree of stenosis were increased, the differences were statistically significant (P<0.05). The ROC curve showed that the area under the curve of blood flow in diagnosing fistula stenosis was the highest (AUC=0.964), followed by flow velocity ratio (AUC=0.903) and stenosis (AUC=0.823), and internal diameter of fistula (AUC=0.697) was the smallest. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value by blood flow (<482.62 mL/min) for predicting stenosis were significantly higher than other indices (P<0.05). The diagnostic efficacy of color Doppler ultrasonography for diagnosing arteriovenous fistula thrombosis was similar to that of angiography（Kappa=0.931, P<0.001）. Conclusions: For the evaluation of stenosis and thrombosis of autologous arteriovenous fistula, color Doppler ultrasonography has a high application value, blood flow (less than 482.62 mL/min) predicts the presence of arteriovenous fistula stenosis.

Key words: Autogenous arteriovenous fistula, Stenosis, Thrombosis, Ultrasound, Doppler

中图分类号:

R445.1

冯薇, 朱好辉. 彩超在评估自体动静脉内瘘狭窄、血栓生成情况中的应用价值分析[J]. 诊断学理论与实践, 2019, 18(03): 360-364.

FENG Wei, ZHU Haohui. Value of color Doppler ultrasonography in evaluation of stenosis and thrombosis of autogenous arteriovenous fistula[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 360-364.

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一般资料	大致正常组(n=30)	狭窄组(n=38)	血栓组(n=28)	χ²/t值	P值
年龄(岁)	54.56±8.13	56.14±8.74	55.66±8.82	0.293	0.747
体质量指数(kg/m²)	24.34±2.01	24.52±2.16	24.12±2.07	0.296	0.744
性别（男/女）	17/13	20/18	13/15	0.268	0.605
透析龄(月)	39.13±9.31	37.02±9.02	37.36±8.53	0.509	0.603
AVF使用时间(月)	28.22±6.35	29.12±6.49	27.95±6.31	0.316	0.731
肾衰竭原因[n(%)]
肾小球肾炎	19(63.33)	26(68.42)	20(71.43)	4.882	0.712
糖尿病肾病	8(26.67)	10(26.32)	6(21.43)
高血压肾病	2(6.67)	1(2.63)	2(7.14)
肾盂肾炎	1(3.33)	0(0)	0(0)
梗阻性肾病	0(0)	1(2.63)	0(0)

组别	例数	桡动脉内径(mm)	瘘口内径(mm)	头静脉内径(mm)	流速比值	狭窄程度(%)	血流量(mL/min)
大致正常组	30	3.56±0.58	3.37±0.29	3.95±0.51	2.40±0.21	42.54±14.07	656.52±121.63
单纯狭窄组	38	3.45±0.37	3.01±0.17^a)	3.37±0.48^a)	2.79±0.19^a)	58.62±10.36^a)	404.95±108.29^a)
血栓形成组	28	3.42±0.49	3.12±0.20^a),b）	3.10±0.59^a）,b)	2.68±0.26^a),b)	64.20±9.68^a),b)	238.76±117.13^a),b)

彩超指标	最佳临界值	AUC	标准误差	P值	95% CI
头静脉内径	3.49 mm	0.708	0.060	0.002	0.591~0.826
瘘口内径	3.15 mm	0.697	0.058	0.003	0.584~0.810
流速比	2.61	0.903^a),b)	0.034	<0.001	0.837~0.969
狭窄度	49.76%	0.823^a),b),c)	0.049	<0.001	0.728~0.918
血流量	482.62 mL/min	0.964^a),b),c),d)	0.017	<0.001	0.930~0.997

彩超指标	准确率	灵敏度	特异度	阳性预测值	阴性预测值
头静脉内径	72.09%	71.43%	73.33%	83.33%	57.89%
瘘口内径	74.42%	73.21%	76.67%	82.00%	60.53%
流速比	86.05%^e)	87.50%^e),f)	83.33%	90.74%	78.13%
狭窄度	81.40%	83.93%^e)	76.67%	87.04%	71.88%
血流量	93.02%^e),f),h)	92.86%^e),f)	93.33%^e),f),h)	96.30%	87.50%