彩超评估血液透析患者动静脉内瘘血栓及狭窄的临床价值

Application value of ultrasound in evaluating the thrombus and stenosis of arteriovenous fistula in hemodialysis patients

目的探讨彩超评估血液透析患者动静脉内瘘血栓及狭窄的临床价值。方法选择2014年6月至2016年6月期间在宝鸡市中医医院接受慢性血液透析治疗并行动静脉造瘘者100例为研究对象,所有患者均接受彩超检查,观察受检者动静脉内瘘通畅及异常的彩超表现、吻合口面积与血流量关系。以ROC曲线分析彩超对血液透析患者动静脉瘘血栓及狭窄的诊断情况。结果共显示动静脉瘘血栓形成21例,其中头静脉18例,瘘口3例;动静脉瘘口狭窄24例,瘘口内径1.1~2.4 mm,平均(2.1±0.2)mm;100例患者中,吻合口面积3~4 mm^2者数量最多,为38例,4~8 mm^2者数量最少,为27例;随着吻合口面积增加,血流量明显增加,差异具有统计学意义(F=34.187,P<0.05);ROC曲线分析显示,彩超血流量评估动静脉瘘血栓及狭窄,其线下面积为0.85(95%CI=0.75~0.90),以彩超血流量<330 mL/min为诊断标准,彩超血流量评估动静脉瘘血栓及狭窄的灵敏度、特异度分别为95%和88%;采用彩超血流量及彩色多普勒联合评估动静脉瘘血栓及狭窄,其线下面积为0.96(95%CI=0.91~0.99)。结论在血液透析患者动静脉内瘘血栓及狭窄的评估中,彩超具有很高的临床应用价值。

Objective To evaluate the clinical value of ultrasonography in evaluating the thrombus and steno- sis of arteriovenous fistula in hemodialysis patients. Methods A total of 100 cases of chronic hemodialysis patients, who admitted to Baoji Hospital of Traditional Chinese Medicine and treated with arteriovenous fistula from June 2014 to June 2016, were selected as research subjects. Ultrasound examination was performed to observe the patency of the inter- nal arteriovenous fistula of the subjects and the abnormal ultrasound findings, and the relationship between anastomotic area and blood flow volume was analyzed. The diagnosis of arteriovenous fistula thrombosis and stenosis in hemodialy- sis patients was analyzed by ROC curve. Results There were 21 cases of arteriovenous fistula thrombosis, including 18 cases of the first vein, 3 cases of fistula. There were 24 cases of arteriovenous fistula stenosis with the diameter of 1. 1 2.4 mm and the average diameter of （2.1±0.2） mm. In 100 patients, the anastomosis area of 3-4 mm2 was the most with 38 cases, and the anastomosis area of 4-8 mm2 was least with 27 cases. The blood flow increased significantly with the increase of the anastomotic area （F=34.187, P〈0.05）. ROC curve analysis showed that the area under the curve was 0.85 in the evaluation of thrombosis and stenosis of arteriovenous fistula with ultrasound blood flow （95%CI=0.75-0.90）. Tak- ing ultrasound blood flow 〈330 mL/min as diagnostic criteria, the sensitivity and specificity of ultrasound blood flow in evaluating the thrombus and stenosis of arteriovenous fistula were 95% and 88%, respectively. The thrombus and stenosis of arteriovenous fistula were assessed by ultrasound blood flow and color Doppler with the area below the line for 0.96 （95%CI=0.91-0.99）. Conclusion Ultrasound has a high clinical value in the assessment of arterial venous fistula thrombosis and stenosis in hemodialysis patients.