摘要
目的:探究超高频超声联合B-Flow评估血液透析患者自体动静脉内瘘(autogenous arteriovenous fistula,AVF)狭窄对流量不足的诊断价值。方法:选取2017年11月—2020年5月在本院行超声检查中出现AVF狭窄的血液透析患者共114例,进行回顾性研究。超高频超声联合B-Flow检测内瘘狭窄处残余内径、收缩期峰值流速(peak systolic velocity,PSV)、收缩期峰值流速比值(peak systolic velocity ratio,PSVR)及自然血流量,进行相关性分析后,以受试者工作特征(receiver operating characteristic,ROC)曲线分析诊断效能。结果:AVF狭窄超声表现为透析通路上内径及血流束变细,流速升高。内瘘狭窄处残余内径与自然血流量正相关(r=0.761,P<0.0001);PSV与自然血流量不存在相关性;PSVR与自然血流量负相关(r=-0.457,P<0.0001)。与PSVR相比,残余内径与自然血流量相关性更高(Z=3.7627,P=0.0002)。残余内径诊断自然血流量不足曲线下面积(area under curve,AUC)为0.880(95%CI:0.809~0.936,P<0.0001),最佳临界值为1.0 mm,灵敏度为82.22%、特异度为84.06%。PSVR诊断自然血流量不足AUC为0.767(95%CI:0.678~0.841,P<0.0001),最佳临界值为4.9,灵敏度为73.33%、特异度为72.46%。与PSVR相比,残余内径诊断自然血流量不足AUC更大(P=0.0082)。两者联合诊断AUC为0.883(95%CI:0.809~0.936,P<0.0001),大于PSVR诊断自然血流量不足AUC(P=0.0017)。结论:内瘘狭窄处残余内径诊断自然血流量不足的效能优于PSVR,可作为一种有效方法为临床判断采取干预措施的时机提供帮助。
Objective:To explore the value of autogenous arteriovenous fistula(AVF)stenosis assessed by ultrahigh frequency(UHF)ultrasound combined with B-Flow for insufficient flow in hemodialysis patients.Methods:From November 2017 to May 2020,a total of 114 hemodialysis patients with AVF stenosis in our hospital were selected for a retrospective study.UHF ultrasound combined with B-Flow examination was performed to observe and to detect the residual inner diameter,peak systolic velocity(PSV),peak systolic velocity ratio(PSVR)and blood flow of the fistula stenosis.After correlation analysis,the diagnostic efficacy was analyzed by receiver operating characteristic(ROC)curve.Results:The ultrasonography of AVF stenosis showed that the inner diameter of the dialysis access reduced,the blood flow bundle became thinner,and the flow velocity increased.The inner diameter of the fistula stenosis was positively correlated with the blood flow(r=0.761,P<0.0001).There was no correlation between the PSV of the stenosis and the blood flow.The PSVR of the stenosis was negatively correlated with the blood flow(r=-0.457,P<0.0001).The correlation coefficient between the residual inner diameter and the blood flow was greater than that between the PSVR and the flow(Z=3.7627,P=0.0002).The area under curve(AUC)of the residual inner diameter of the fistula stenosis for diagnosing insufficient blood flow was 0.880(95%CI=0.809~0.936,P<0.0001),the optimal cut-off value was 1.0 mm,the sensitivity was 82.22%and the specificity was 84.06%.The AUC of PSVR of the fistula stenosis for diagnosing insufficient blood flow was 0.767(95%CI=0.678~0.841,P<0.0001),the optimal cut-off value was 4.9,the sensitivity was 73.33%and the specificity was 72.46%.The AUC of the residual inner diameter of the fistula stenosis for diagnosing insufficient blood flow was significantly greater than that of PSVR(P=0.0082).The AUC of combined diagnosis for insufficient blood flow was 0.883(95%CI=0.809~0.936,P<0.0001),which was significantly greater than the AUC of PSVR of the fistula stenosis for diagnosing insufficient blood flow(P=0.0017).Conclusion:The residual inner diameter is more effective than PSVR in diagnosing insufficient blood flow,which can be used as an efficient method to provide guidance for early clinical interference.
作者
王娅妮
敬雷
WANG Yani;JING Lei(Department of Ultrasonography,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2020年第12期1860-1864,共5页
Journal of Nanjing Medical University(Natural Sciences)
关键词
超声
动静脉内瘘
狭窄
血流量
血液透析
ultrasonography
arteriovenous fistula
blood flow
stenosis
hemodialysis
