慢性静脉疾病评分与反流时间评估疾病严重程度的价值比较

Comparison of clinical severity score and reflux time in the assessment of chronic venous disease

目的比较慢性静脉疾病评分与反流时间评估疾病严重程度的价值。方法回顾性分析2017年11月至2020年7月空军军医大学西京医院超声科诊断的507例原发性反流型慢性静脉疾病(chronic venous disease,CVD)患者,根据CEAP分级进行分组比较,以受试者工作特征曲线分析探究静脉临床严重程度评分(venous clinical severity score,VCSS)及沉重感/疼痛/肿胀/痉挛/瘙痒(heaviness/ache/swelling/throbbing/itching,HASTI)评分用于评估疾病严重程度的截点值。结果在各类型的反流病例中,VCSS随着疾病严重程度的增大而增大(P<0.05),区分C_(1~2)与C_(3~4)、C_(3~4)与C_(5~6)的截点值分别为3.5~4.5分和8.5~14.5分。HASTI评分在C_(3~4)级显著高于C_(1~2)级(P<0.05),截点值为7.5~9.5分。在单纯浅静脉反流(As)和浅及深静脉合并穿支反流(Asdp)病例中,各临床分级间的反流时间参数差异无统计学意义(P>0.05);在浅静脉合并深静脉反流病例(Asd)中,C_(5~6)级的深静脉反流时间较C_(3~4)级延长(股总静脉:P=0.008;腘静脉:P=0.044);在浅静脉合并胫部穿支静脉反流病例(Asp)中,小隐静脉近心段(P=0.037)和穿支静脉(P=0.0002)的反流时间在C_(3~4)级较C_(1~2)级缩短,同时伴穿支静脉内径增宽(P=0.034)。结论VCSS与HASTI评分用于评估CVD严重程度的参考区间分别为C_(1~6)分级与C_(1~4)分级,反流时间参数仅能区分浅静脉合并深静脉反流终末期病例(C_(3~6)Asd)或浅静脉合并穿支静脉反流早期病例(C_(1~4)Asp)的疾病严重程度。

Objective To compare the value of clinical severity score and reflux time in the assessment of chronic venous diseases(CVD).Methods The clinical data of 507 primary reflux CVD patients diagnosed by the Ultrasound Department of Xijing Hospital of Air Force Military Medical University from November 2017 to July 2020 was analyzed retrospectively.Receiver operating characteristic curve analysis exploring the venous clinical severity score(VCSS)and heaviness/ache/swelling/throbbing/itching(HASTI)score in the evaluation of the cut-off value of disease severity.Results In various types of cases,VCSS increased with the severity of the disease(P<0.05),and the cut-off values for distinguishing C_(1-2) from C_(3-4 )and C_(3-4) from C_(5-6 )were 3.5-4.5 and 8.5-14,respectively.The HASTI score at C_(3-4) was significantly higher than that at C_(1-2)(P<0.05),and the cut-off value was 7.5-9.5.In the cases of simple superficial venous reflux(As)and superficial and deep veins combined with perforator reflux(Asdp),there was no significant difference in reflux time parameters among various clinical grades(P>0.05).In venous reflux cases(Asd),the deep venous reflux time of C_(5-6) was longer than that of C_(3-4)(common femoral vein:P=0.008;popliteal vein:P=0.044).In the case of venous reflux(Asp),the reflux time of the proximal segment of the small saphenous vein(P=0.037)and the perforating vein(P=0.0002)was shortened in C_(3-4) compared with C_(1-2),and the inner diameter of perforating veins were widened(P=0.034).Conclusions The reference intervals of VCSS and HASTI score for evaluating the severity of CVD are C_(1)-C_(6) and C_(1)-C_(4) grades,respectively.The reflux time parameter can only distinguish end-stage cases of superficial veins with deep venous reflux(C_(3-6)A_(sd))or early-stage cases of venous complicated perforator reflux(C_(1~4)A_(sp)).