基于超声视野下的肾动脉栓塞诊断分析
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摘要
目的:探讨基于超声临床实例视野下肾动脉栓塞诊断价值。方法:选取2014年12月—2017年11月我院诊治疑似肾动脉栓塞23例(46根肾动脉)行回顾性分析,采用二维超声进行初步诊断,以肾动脉造影或CT/MRI血管造影诊断为"金标准",判定超声在肾动脉栓塞中诊断灵敏度、特异性、阳性预测值、阴性预测值及阳性符合率,以"金标准"将46根肾动脉分为栓塞组和未栓塞组,比较两组肾长径(L)、阻力指数(RI)和收缩期血流峰值流速(PSV)。结果:超声在肾动脉栓塞中诊断灵敏度为100.00%,特异性为90.24%,阳性预测值为55.56%,阴性预测值为100.00%,阳性符合率为91.30%。两组患者肾长径比较差异无统计学意义(P>0.05);栓塞组患者RI值低于未栓塞组,PSV值高于未栓塞组(P<0.05)。结论:超声在肾动脉栓塞中诊断具有较高灵敏度、特异性及符合率,具有较高临床应用价值。
Objective: To explore the diagnostic value of renal functional embolism based on the clinical perspective of ultrasound. Methods: Select 23 cases of suspected renal embolism( 46 renal arteries) in our hospital from Dec 2014 to Nov2017 as retrospective analysis,two-dimensional ultrasound was used for the initial diagnosis. Renal artery angiography or CT/MRI angiography was used to diagnose the"gold standard". The diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and positive coincidence rate of ultrasound in renal embolism were determined. The 46 renal arteries were divided into the embolization group and the non-embolization group by the"gold standard". The length of the kidney( L),the resistance index( RI),and the peak systolic flow velocity( PSV) were compared between the two groups. Results:The sensitivity of ultrasound in renal artery embolization was 100. 00%,the specificity was 90. 24%,the positive predictive value was 55. 56%,the negative predictive value was 100. 00%,and the positive coincidence rate was 91. 30%. There was no statistically significant difference in renal length between the two groups( P > 0. 05). The RI value in the embolization group was lower than that in the non-embolization group,and the PSV value was higher in the embolization group than in the non-embolization group( P < 0. 05). Conclusion: Ultrasound in the diagnosis of renal artery embolism has a higher sensitivity,specificity and compliance rate,with a higher clinical value.
Objective: To explore the diagnostic value of renal functional embolism based on the clinical perspective of ultrasound. Methods: Select 23 cases of suspected renal embolism( 46 renal arteries) in our hospital from Dec 2014 to Nov2017 as retrospective analysis,two-dimensional ultrasound was used for the initial diagnosis. Renal artery angiography or CT/MRI angiography was used to diagnose the"gold standard". The diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and positive coincidence rate of ultrasound in renal embolism were determined. The 46 renal arteries were divided into the embolization group and the non-embolization group by the"gold standard". The length of the kidney( L),the resistance index( RI),and the peak systolic flow velocity( PSV) were compared between the two groups. Results:The sensitivity of ultrasound in renal artery embolization was 100. 00%,the specificity was 90. 24%,the positive predictive value was 55. 56%,the negative predictive value was 100. 00%,and the positive coincidence rate was 91. 30%. There was no statistically significant difference in renal length between the two groups( P > 0. 05). The RI value in the embolization group was lower than that in the non-embolization group,and the PSV value was higher in the embolization group than in the non-embolization group( P < 0. 05). Conclusion: Ultrasound in the diagnosis of renal artery embolism has a higher sensitivity,specificity and compliance rate,with a higher clinical value.
引文
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[6]郭曦,李彭,刘光锐,等.血流储备分数在Stanford B型主动脉夹层累及肾动脉患者介入治疗中的应用[J].中华心血管病杂志,2015,43(10):854-857.
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[8]邱敏,向军吉,马潞林,等.实时超声监测后腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):730-734.
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[11]张春莉,刘琨,陈飞,等.彩色多普勒超声对老年肾动脉狭窄程度诊断准确性的评估[J].中华老年心脑血管病杂志,2017,19(12):1268-1271.
[12]Castelli PK,Dillman JR,Kershaw DB,et al.Renal sonography with Doppler for detecting suspected pediatric renin-mediated hypertension-Is it adequate?[J].Pediatric radiology,2014,44(1):42-49.
[13]丁苗苗,吴文芳,杨冬,等.超声诊断外伤致肾动脉血栓一例[J].中华医学超声杂志:电子版,2015,12(4):341-342.
[14]郭曦,李彭,刘光锐,等.血流储备分数在肾动脉狭窄腔内修复术中的应用价值[J].中华心血管病杂志,2015,43(5):413-417.
[15]Pathak A,Coleman L,Roth A,et al.Renal sympathetic nerve denemation using intraluminal ultrasound within a cooling balloon preserves the arterial wall and reduces sympathetic nerve activity[J].Euro Intervention,2015,11(4):477-484.
[16]Prejbisz A,Sellin L,Szwench-Pietrasz E,et al.Smaller caliber renal arteries are a novel feature of uromodulin-associated kidney disease[J].Kidney International,2015,88(1):160-166.
[2]Granata A,Floccari F,Clementi A,et al.Contrast-enhanced ultrasound reveals renal artery aneurysm after detection of'parapelvic lithiasis’[J].Clinical and experimental nephrology,2014,18(1):174-175.
[3]Del Conde I,Galin ID,Trost B,et al.Renal artery duplex ultrasound criteria for the detection of significant in-stent restenosis[J].Catheterization and cardiovascular interventions:Official journal of the Society for Cardiac Angiography&Interventions,2014,83(4):612-618.
[4]王旭珍,薛武军,丁小明,等.彩色多普勒超声诊断移植肾动脉狭窄的临床应用价值[J].中华器官移植杂志,2016,37(9):537-540.
[5]Kawasaki D,Fujii K,Fukunaga M,et al.Safety and Efficacy of Carbon Dioxide and Intravascular Ultrasound-Guided Stenting for Renal Artery Stenosis in Patients With Chronic Renal Insufficiency[J].Angiology:the Journal of Vascular Diseases,2015,66(3):231-236.
[6]郭曦,李彭,刘光锐,等.血流储备分数在Stanford B型主动脉夹层累及肾动脉患者介入治疗中的应用[J].中华心血管病杂志,2015,43(10):854-857.
[7]叶子兴,陈跃鑫,游燕,等.第393例双肾动脉闭塞—腹膜后肿物—反复假性动脉瘤形成[J].中华医学杂志,2017,97(2):146-149.
[8]邱敏,向军吉,马潞林,等.实时超声监测后腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):730-734.
[9]Yoo JK,Hwang MH,Luttrell MJ,et al.Higher levels of adiponectin in vascular endothelial cells are associated with greater brachial artery flow-mediated dilation in older adults[J].Experimental Gerontology,2015,63:1-7.
[10]李娜,刘晓娜,郑海宁,等.兔急性肾动脉狭窄对肾脏组织弹性的影响[J].中华医学超声杂志:电子版,2017,14(3):232-235.
[11]张春莉,刘琨,陈飞,等.彩色多普勒超声对老年肾动脉狭窄程度诊断准确性的评估[J].中华老年心脑血管病杂志,2017,19(12):1268-1271.
[12]Castelli PK,Dillman JR,Kershaw DB,et al.Renal sonography with Doppler for detecting suspected pediatric renin-mediated hypertension-Is it adequate?[J].Pediatric radiology,2014,44(1):42-49.
[13]丁苗苗,吴文芳,杨冬,等.超声诊断外伤致肾动脉血栓一例[J].中华医学超声杂志:电子版,2015,12(4):341-342.
[14]郭曦,李彭,刘光锐,等.血流储备分数在肾动脉狭窄腔内修复术中的应用价值[J].中华心血管病杂志,2015,43(5):413-417.
[15]Pathak A,Coleman L,Roth A,et al.Renal sympathetic nerve denemation using intraluminal ultrasound within a cooling balloon preserves the arterial wall and reduces sympathetic nerve activity[J].Euro Intervention,2015,11(4):477-484.
[16]Prejbisz A,Sellin L,Szwench-Pietrasz E,et al.Smaller caliber renal arteries are a novel feature of uromodulin-associated kidney disease[J].Kidney International,2015,88(1):160-166.