胡桃夹综合征超声诊断标准的研究

Investigation of diagnostic standards of nutcracker syndrome with ultrasound

目的探讨胡桃夹综合征的超声诊断标准。方法62例患者和62例对照者平卧位、左侧卧位时于肠系膜上动脉(SMA)和腹主动脉(AO)夹角处测量左肾静脉内径(D1),左肾静脉近肾端最宽处内径(D2),SMA和AO夹角、血流峰值速度(Vmax)和时间平均峰值速度(Vtap);站立15min后于站立位、站立背伸位重复测量上述指标,并根据Vmax和Vtap计算夹角处与下腔静脉间的压差(ΔPv、ΔPtap),并对各种诊断标准进行对比分析。结果胡桃夹综合征患者存在左肾静脉血液回流障碍,与其他诊断标准相比,以4mmHg为临界值的ΔPtap诊断胡桃夹综合征的准确性(95.97%)、特异性(96.77%)最高。结论左肾静脉夹角处与下腔静脉的ΔPtap是诊断胡桃夹综合征最佳的超声参数。

Objective To Investigate the diagnostic standards of nutcracker syndrome with ultrasound. Methods The left renal vein was measured on horizontal decubitus and sinistral decubitus in 62 patients and 62 control by ultrasound, the parameters included interior diameter between superior mesenteric artery （SMA） and abdominal aorta（AO）（ D1 ）, proximal interior diameter of left renal vein（D2 ）, SMA, AO, flow veloeity（Vmax） and time average peak velocity（ Vtap）. Then each person stood for 15 minutes, those parameters were measured again on upright position and back- unbend upright position. △Pv and △ptap between interior diameter among SMA and AO and inferior vena cava were calculated according to Vmax and Vtap, diagnostic standards of nutcracker syndrome were analyzed. Results There is difference with △Ptap between noroml and the nutcracker patients. Compared to others methods, taking 4 mmHg as the cut-off, △Ptap has the highest specificity（96.77%） and accuracy（95.97%） in diagnosis of nutcracker syndrome. Conclusion △Ptap is the best ultrasound standards in diagnosis of nutcracker syndromce.