64排CTA在糖尿病下肢血管病变中的应用
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摘要
目的探讨64排螺旋CT血管成像(CTA)在糖尿病下肢血管病变中的应用。方法选择2017年5月-2018年5月入院接受下肢血管检查的糖尿病患者102例(血管共计1850段)进行回顾性分析。所有患者均接受CTA检查和多普勒彩超检查,以数字减影血管造影(DSA)结果为金标准,比较上述两种方法对糖尿病下肢病变的敏感度、特异度、准确度和Kappa值;比较CTA和DSA检测出糖尿病患者下肢血管病变程度;记录CTA检查出血管病变的分布情况。结果与金标准(DSA)比,CTA对下肢血管病变的灵敏度为0.961,特异度为0.792,准确度为0.916,Kappa值为0.778,均大于多普勒彩超检查(灵敏度为0.849,特异度为0.566,准确度为0.773,Kappa值为0.417);CTA对糖尿病患者下肢血管病变轻度狭窄、中度狭窄、重度狭窄和闭塞的检出率与DSA比较,差异无统计学意义(P>0.05);经研究,31.37%(32/102)的患者表现为腘动脉狭窄或闭塞,29.41%(30/102)的患者表现为股动脉狭窄或闭塞,12.75%(13/102)的患者表现为腹主动脉狭窄或闭塞,14.71%(15/102)的患者表现为小腿动脉狭窄或闭塞,11.76%(12/102)的患者表现髂动脉狭窄或闭塞。结论 64排CTA对糖尿病患者下肢血管病变检测结果较为可靠,敏感度及特异度较高,能准确反映患者血管病变情况。
Objective To investigate the application of 64-slice spiral CT angiography(CTA) in diabetic lower extremity vascular disease. Methods A total of 102 cases of patients with diabetes mellitus(a total of 1850 vessels) who underwent lower extremity vascular examination from May 2017 to May 2018 were analyzed retrospectively.All patients were given CTA and color Doppler ultrasound. The digital subtraction angiography(DSA) results were used as the gold standard to compare the sensitivity,specificity, accuracy and Kappa value of the two methods. The degree of lower extremity vascular disease of diabetic patients detected by CTA and DSA was compared. The distribution of vascular disease was recorded by CTA. Results Compared with the gold standard(DSA), the sensitivity, specificity, accuracy and the Kappa value of CTA in lower extremity vascular disease were 0.961, 0.792, 0.916 and 0.778, which were greater than those of color Doppler ultrasound with 0.849, 0.566, 0.773 and 0.417. There was no significant difference between CTA and DSA in the detection rates of mild stenosis,moderate stenosis, severe stenosis and occlusion of lower extremity vascular disease in diabetic patients(P>0.05). By study, 31.37%(32/102) patients showed popliteal artery stenosis or occlusion, and 29.41%(30/102) patients showed femoral artery stenosis or occlusion, and 12.75%(13/102) patients showed abdominal aorta stenosis or occlusion,and 14.71%(15/102) patients showed stenosis or occlusion of calf artery, and 11.76%(12/102) patients showed stenosis or occlusion of iliac artery. Conclusion 64-slice CTA is reliable for the detection of lower extremity vascular disease in diabetic patients, and it has high sensitivity and specificity, and can accurately reflect the vascular lesions of patients.
Objective To investigate the application of 64-slice spiral CT angiography(CTA) in diabetic lower extremity vascular disease. Methods A total of 102 cases of patients with diabetes mellitus(a total of 1850 vessels) who underwent lower extremity vascular examination from May 2017 to May 2018 were analyzed retrospectively.All patients were given CTA and color Doppler ultrasound. The digital subtraction angiography(DSA) results were used as the gold standard to compare the sensitivity,specificity, accuracy and Kappa value of the two methods. The degree of lower extremity vascular disease of diabetic patients detected by CTA and DSA was compared. The distribution of vascular disease was recorded by CTA. Results Compared with the gold standard(DSA), the sensitivity, specificity, accuracy and the Kappa value of CTA in lower extremity vascular disease were 0.961, 0.792, 0.916 and 0.778, which were greater than those of color Doppler ultrasound with 0.849, 0.566, 0.773 and 0.417. There was no significant difference between CTA and DSA in the detection rates of mild stenosis,moderate stenosis, severe stenosis and occlusion of lower extremity vascular disease in diabetic patients(P>0.05). By study, 31.37%(32/102) patients showed popliteal artery stenosis or occlusion, and 29.41%(30/102) patients showed femoral artery stenosis or occlusion, and 12.75%(13/102) patients showed abdominal aorta stenosis or occlusion,and 14.71%(15/102) patients showed stenosis or occlusion of calf artery, and 11.76%(12/102) patients showed stenosis or occlusion of iliac artery. Conclusion 64-slice CTA is reliable for the detection of lower extremity vascular disease in diabetic patients, and it has high sensitivity and specificity, and can accurately reflect the vascular lesions of patients.
引文
[1]温晓晓,金凤表,张力辉,等.1,5脱水葡萄糖醇与2型糖尿病相关研究进展[J].河北医药,2017,39(10):1576-1579.
[2]Al-Rubeaan K,Al-Manaa H A,Khoja TA,et al.Epidemiology of abnormal glucose metabolism in a country facing its epidemic:SAUDI-DM study[J].Journal of Diabetes,2015,7(5):622-632.
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[5]Lim J C,Ranatunga D,Owen A,et al.Multidetector(64+)Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease:Assessment of Image Quality and Accuracy in a Tertiary Care Setting[J].Journal of Computer Assisted Tomography,2016,41(2):327.
[6]叶浩祥,杨志勇,武庆利,等.64排128层螺旋CT联合彩色多普勒超声诊断糖尿病下肢血管病变[J].罕少疾病杂志,2017,24(6):47-50.
[7]高清歌,祝超瑜,魏丽,等.住院2型糖尿病患者血管病变发生情况及影响因素分析[J].中国糖尿病杂志,2015,23(3):203-206.
[8]付饶,刘渤,张桂红.前列地尔对早期糖尿病肾病患者血管内皮功能的影响[J].中国中西医结合肾病杂志,2015,16(5):446-447.
[9]毛骞,许卫东,孔宪哲.双能CTA对2型糖尿病下肢血管病变的评估及危险因素相关性研究[J].中国地方病防治杂志,2017,32(4):408-410.
[10]孙建浩,来永飞,诸纪明.彩色多普勒超声在诊断老年2型糖尿病下肢血管病变中的应用[J].中华全科医学,2016,14(1):116-118.
[11]韩宏程.多排螺旋CT冠脉血管造影在冠心病中的应用研究[J].CT理论与应用研究,2015,24(6):843-848.
[12]唐涛,周鹏,王朝晖,等.CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(5):383-387.
[13]梁昱,张晓琴.多排螺旋CT冠状动脉成像研究进展[J].CT理论与应用研究,2016,25(6):725-735.
[14]黄强,王剑锋,翟仁友,等.无创影像检查方法诊断糖尿病下肢动脉病变的价值[J].中华放射学杂志,2015,49(1):20-24.
[15]周璠娅.彩色多普勒超声在2型糖尿病下肢动脉粥样硬化血管病变中的诊断价值[J].现代中西医结合杂志,2015,24(18):2027-2029.
[2]Al-Rubeaan K,Al-Manaa H A,Khoja TA,et al.Epidemiology of abnormal glucose metabolism in a country facing its epidemic:SAUDI-DM study[J].Journal of Diabetes,2015,7(5):622-632.
[3]李筱荣,刘巨平.重视糖尿病眼部并发症的诊断和治疗[J].中华实验眼科杂志,2017,35(7):577-580.
[4]龚李艳,沈慧君,董中兴,等.糖尿病与非糖尿病下肢血管病变多层螺旋CT影像特征对比研究[J].中国CT和MRI杂志,2017,15(12):124-126.
[5]Lim J C,Ranatunga D,Owen A,et al.Multidetector(64+)Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease:Assessment of Image Quality and Accuracy in a Tertiary Care Setting[J].Journal of Computer Assisted Tomography,2016,41(2):327.
[6]叶浩祥,杨志勇,武庆利,等.64排128层螺旋CT联合彩色多普勒超声诊断糖尿病下肢血管病变[J].罕少疾病杂志,2017,24(6):47-50.
[7]高清歌,祝超瑜,魏丽,等.住院2型糖尿病患者血管病变发生情况及影响因素分析[J].中国糖尿病杂志,2015,23(3):203-206.
[8]付饶,刘渤,张桂红.前列地尔对早期糖尿病肾病患者血管内皮功能的影响[J].中国中西医结合肾病杂志,2015,16(5):446-447.
[9]毛骞,许卫东,孔宪哲.双能CTA对2型糖尿病下肢血管病变的评估及危险因素相关性研究[J].中国地方病防治杂志,2017,32(4):408-410.
[10]孙建浩,来永飞,诸纪明.彩色多普勒超声在诊断老年2型糖尿病下肢血管病变中的应用[J].中华全科医学,2016,14(1):116-118.
[11]韩宏程.多排螺旋CT冠脉血管造影在冠心病中的应用研究[J].CT理论与应用研究,2015,24(6):843-848.
[12]唐涛,周鹏,王朝晖,等.CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(5):383-387.
[13]梁昱,张晓琴.多排螺旋CT冠状动脉成像研究进展[J].CT理论与应用研究,2016,25(6):725-735.
[14]黄强,王剑锋,翟仁友,等.无创影像检查方法诊断糖尿病下肢动脉病变的价值[J].中华放射学杂志,2015,49(1):20-24.
[15]周璠娅.彩色多普勒超声在2型糖尿病下肢动脉粥样硬化血管病变中的诊断价值[J].现代中西医结合杂志,2015,24(18):2027-2029.