无创检查在糖尿病足下肢血管病变中的诊断价值与DSA对照研究

Non-invasive detection in the diagnosis of lower limb arterial disease in the diabetes:a comparative study with DSA

目的:探讨各无创检查在糖尿病患者下肢血管病变中的应用价值。方法:对41例怀疑糖尿病下肢血管病变患者进行X线数字减影血管造影(DSA)及无创性血管检查,并将检查得到的患肢分级情况及各段相应血管的分级结果相比较。结果:①将各无创检查按有无病变分级,并与DSA结果进行比较,发现各无创检查与DSA检查结果无明显统计学差异,其中患肢疼痛分级的准确度75.61%,敏感度85.29%,特异度28.57%;患肢皮温测定的准确度87.18%,敏感度87.88%,特异度83.33%;踝/肱指数(ABI)的准确度84.21%,敏感度84.85%,特异度80%;下肢彩色超声检查的准确度80.56%,敏感度82.72%,特异度74.07%;磁共振血管造影(MRA)的准确度93.75%,敏感度97.33%,特异度80.95%;②将疼痛、ABI、彩超、MRA检查精确分级后,与DSA的符合率分别为60.98%、60.53%、70.37%、84.38%。结论:通过各项无创检查,可基本确定病变性质、部位及严重程度,但疼痛分级符合率较低、皮温测定受外在因素影响,ABI易漏诊,彩超有低估病变的缺陷,MRA有高估病变的缺陷,还不能完全替代DSA检查。

Objective：To explore the diagnostic value of non-invasive detection in lower limb arterial disease of diabetic patients.Methods：Non-invasive detection was performed in 41 cases suspected of diabetic lower extremity arterial disease,and the results were compared with that of DSA.Results： ①There was no statistically significant difference between non-invasive detection and DSA in the diagnosis of diabetic lower limb arterial disease.Compared with DSA,the accordance rate,sensitivity and specificity of the painful degree were 75.61%,85.29% and 28.57%,respectively.The accordance rate,sensitivity and specificity of skin temperature detection were 87.18%,87.88% and 83.33%,respectively.The accordance rate,sensitivity and specificity of ABI were 84.21%,84.85% and 80%,respectively.The accordance rate,sensitivity and specificity of color Doppler ultrasound were 80.56%,82.72% and 74.07%,respectively.The accordance rate,sensitivity and specificity of MRA were 93.75%,97.33% and 80.95%,respectively;② In accurate assessment of the degree of arterial stenosis,the accordance rate of painful degree,ABI,Duplex and MRA were 60.98%,60.53%,70.37%,84.38%,respectively,compared with that of DSA.Conclusion：The accordance rate of painful degree was still lower,skin temperature detection was affected by many outside factors,ABI might be omission,color Doppler ultrasound had defect of under-evaluation,MRA had defect of over-evaluation,so non-invasive method could not replace DSA completely at present.