糖尿病下肢动脉硬化闭塞症诊断中螺旋CT的应用及其临床价值
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摘要
目的探讨多层螺旋CT血管成像技术(MSCTA)应用于糖尿病下肢动脉硬化闭塞症(ASO中的临床诊断效果及价值。方法选取58例糖尿病ASO患者作为研究对象,分别给予数字减影血管造影(DSA)、MSCTA检查,以DSA诊断结果作为金标准,回顾性分析MSCTA的应用效果。结果 58例患者共有1200支动脉节段, MSCTA诊断可评估节段为1120支(93.33%)。在下肢动脉狭窄程度评估方面, DSA检查结果显示, 572支(51.07%)为Ⅰ级, 87支(7.77%)为Ⅱ级, 121支(10.80%)为Ⅲ级, 127支(11.34%)Ⅳ级, 213支(19.02%)为Ⅴ级;MSCTA检查结果显示, 572支(51.07%)为Ⅰ级, 86支(7.68%)为Ⅱ级, 107支(9.55%)为Ⅲ级, 137支(12.23%)为Ⅳ级, 218支(19.46%)为Ⅴ级。两种检查方式评估结果具有良好一致性,比较差异无统计学意义(P>0.05)。以DSA诊断结果作为金标准, MSCTA在骼外动脉、骼总动脉、股浅动脉、骼内动脉等各病变部位诊断上均表现出较高特异度、敏感度、准确度以及阴性、阳性预测值。结论 MSCTA应用于糖尿病ASO诊断,可清晰显示下肢动脉病变节段部位及狭窄程度,且诊断特异度、敏感度、准确度均较高,可作为该病诊断首选方法。
Objective To discuss the clinical diagnostic effect and value of multi-slice spiral CT angiography(MSCTA) in diabetic lower extremity arteriosclerosis obliterans(ASO). Methods A total of 58 patients with diabetic ASO were selected as subjects, and digital subtraction angiography(DSA) and MSCTA were performed respectively. The DSA diagnosis was used as the gold standard to retrospectively analyze the application effect of MSCTA. Results There were 1200 arterial segments in 58 patients and 1120(93.33%) in the MSCTA diagnosis. In evaluating the degree of arterial stenosis in the lower extremities, DSA results showed that 572 arteries(51.07%) were grade I, 87 arteries(7.77%) were grade Ⅱ, 121 arteries(10.80%) were grade Ⅲ, 127 arteries(11.34%) were grade IV and 213 arteries(19.02%) were grade V. MSCTA results showed that 572 arteries(51.07%)were grade I, 86 arteries(7.68%) were grade Ⅱ, 107 arteries(9.55%) were grade Ⅲ, 137 arteries(12.23%)were grade IV and 218 arteries(19.46%) were grade V. The results of the two examination methods were in good agreement, and the differences were not statistically significant(P>0.05). With DSA as the gold standard,MSCTA showed high specificity, sensitivity, accuracy, negative and positive predictive value in the diagnosis of lesions such as extraskeletal artery, common skeletal artery, superficial femoral artery and internal skeletal artery.Conclusion Application of MSCTA in diagnosis of diabetic ASO can clearly show the location and stenosis degree of lower extremity artery lesions, and the diagnostic specificity, sensitivity and accuracy are high. MSCTA can be used as the preferred method for diagnosis of diabetic ASO.
Objective To discuss the clinical diagnostic effect and value of multi-slice spiral CT angiography(MSCTA) in diabetic lower extremity arteriosclerosis obliterans(ASO). Methods A total of 58 patients with diabetic ASO were selected as subjects, and digital subtraction angiography(DSA) and MSCTA were performed respectively. The DSA diagnosis was used as the gold standard to retrospectively analyze the application effect of MSCTA. Results There were 1200 arterial segments in 58 patients and 1120(93.33%) in the MSCTA diagnosis. In evaluating the degree of arterial stenosis in the lower extremities, DSA results showed that 572 arteries(51.07%) were grade I, 87 arteries(7.77%) were grade Ⅱ, 121 arteries(10.80%) were grade Ⅲ, 127 arteries(11.34%) were grade IV and 213 arteries(19.02%) were grade V. MSCTA results showed that 572 arteries(51.07%)were grade I, 86 arteries(7.68%) were grade Ⅱ, 107 arteries(9.55%) were grade Ⅲ, 137 arteries(12.23%)were grade IV and 218 arteries(19.46%) were grade V. The results of the two examination methods were in good agreement, and the differences were not statistically significant(P>0.05). With DSA as the gold standard,MSCTA showed high specificity, sensitivity, accuracy, negative and positive predictive value in the diagnosis of lesions such as extraskeletal artery, common skeletal artery, superficial femoral artery and internal skeletal artery.Conclusion Application of MSCTA in diagnosis of diabetic ASO can clearly show the location and stenosis degree of lower extremity artery lesions, and the diagnostic specificity, sensitivity and accuracy are high. MSCTA can be used as the preferred method for diagnosis of diabetic ASO.
引文
[1]明道红.3DCE-MRA对下肢动脉硬化闭塞症的诊断价值.河北医学,2017,23(2):315-317.
[2]艾则孜·玉素甫.彩色多普勒超声与DSA在下肢动脉硬化闭塞症中的诊断价值.临床超声医学杂志,2015,17(1):72-73.
[3]兰静,司成海.管电流调制技术在糖尿病下肢动脉CT血管成像中的应用.山西医药杂志,2016,45(20):2377-2378.
[4]宋希涛,刘暴,刘昌伟,等.下肢动脉硬化闭塞症合并无症状颈动脉狭窄发生率及危险因素分析.中华医学杂志,2016,96(2):126-128.
[5]孔爱松.双螺旋CT在糖尿病下肢动脉硬化闭塞症诊断中的应用价值评价.糖尿病新世界,2016,19(9):109-110.
[6]刘影.64排CT用于糖尿病下肢动脉硬化闭塞症患者诊断中的临床研究.双足与保健,2017,26(15):65,71.
[7]梁爽,侯丽辉.下肢动脉硬化闭塞症的临床护理分析.中国卫生标准管理,2017,8(7):153-154.
[8]周辰光.下肢动脉硬化闭塞症合并糖尿病足的介入治疗及其研究进展.医学综述,2015,21(1):109-111.
[9]杨敏,邓辉胜.高龄2型糖尿病患者下肢动脉硬化闭塞症的危险因素研究.中国全科医学,2017,20(1):71-75.
[10]郭平波,董磊,沈晓青,等.基于超声评价加味补阳还五汤联合西药治疗糖尿病下肢动脉硬化闭塞症的疗效观察.江苏中医药,2017,49(11):43-45.
[11]赵新宇,高明杰,王力力,等.超声对糖尿病性下肢动脉硬化闭塞症评估及相关危险因素研究.中国超声医学杂志,2016,32(6):544-546.
[12]张璐妮,刘世军,陈丽波.超声评价糖尿病下肢动脉硬化闭塞症中侧支循环建立的研究进展.中国实验诊断学,2018,22(7):1284-1285.
[13]朱月琳,于同,刘昭,等.下肢动脉硬化闭塞症支架植入术后再狭窄治疗方法的对比研究.中国血管外科杂志(电子版),2018,10(1):32-36.
[14]董军,于林峰,张所宏,等.糖尿病并发下肢动脉硬化闭塞症的综合治疗研究.实用心脑肺血管病杂志,2016,24(1):264-265.
[15]刘乃全,孙广萍.多层螺旋CT(MSCT)灌注评估糖尿病肾病患者肾功能的临床研究.中国CT和MRI杂志,2016,14(5):96-99.
[16]傅丽.糖尿病并下肢动脉硬化闭塞症的诊断与治疗.中国临床研究,2007,20(3):309.
[2]艾则孜·玉素甫.彩色多普勒超声与DSA在下肢动脉硬化闭塞症中的诊断价值.临床超声医学杂志,2015,17(1):72-73.
[3]兰静,司成海.管电流调制技术在糖尿病下肢动脉CT血管成像中的应用.山西医药杂志,2016,45(20):2377-2378.
[4]宋希涛,刘暴,刘昌伟,等.下肢动脉硬化闭塞症合并无症状颈动脉狭窄发生率及危险因素分析.中华医学杂志,2016,96(2):126-128.
[5]孔爱松.双螺旋CT在糖尿病下肢动脉硬化闭塞症诊断中的应用价值评价.糖尿病新世界,2016,19(9):109-110.
[6]刘影.64排CT用于糖尿病下肢动脉硬化闭塞症患者诊断中的临床研究.双足与保健,2017,26(15):65,71.
[7]梁爽,侯丽辉.下肢动脉硬化闭塞症的临床护理分析.中国卫生标准管理,2017,8(7):153-154.
[8]周辰光.下肢动脉硬化闭塞症合并糖尿病足的介入治疗及其研究进展.医学综述,2015,21(1):109-111.
[9]杨敏,邓辉胜.高龄2型糖尿病患者下肢动脉硬化闭塞症的危险因素研究.中国全科医学,2017,20(1):71-75.
[10]郭平波,董磊,沈晓青,等.基于超声评价加味补阳还五汤联合西药治疗糖尿病下肢动脉硬化闭塞症的疗效观察.江苏中医药,2017,49(11):43-45.
[11]赵新宇,高明杰,王力力,等.超声对糖尿病性下肢动脉硬化闭塞症评估及相关危险因素研究.中国超声医学杂志,2016,32(6):544-546.
[12]张璐妮,刘世军,陈丽波.超声评价糖尿病下肢动脉硬化闭塞症中侧支循环建立的研究进展.中国实验诊断学,2018,22(7):1284-1285.
[13]朱月琳,于同,刘昭,等.下肢动脉硬化闭塞症支架植入术后再狭窄治疗方法的对比研究.中国血管外科杂志(电子版),2018,10(1):32-36.
[14]董军,于林峰,张所宏,等.糖尿病并发下肢动脉硬化闭塞症的综合治疗研究.实用心脑肺血管病杂志,2016,24(1):264-265.
[15]刘乃全,孙广萍.多层螺旋CT(MSCT)灌注评估糖尿病肾病患者肾功能的临床研究.中国CT和MRI杂志,2016,14(5):96-99.
[16]傅丽.糖尿病并下肢动脉硬化闭塞症的诊断与治疗.中国临床研究,2007,20(3):309.