股浅动脉狭窄段与胭动脉收缩期峰值流速比值（PSV／PSVpop）在股浅动脉重度狭窄超声诊断中的价值

Value of the ratio of peak systolic velocity of intra-stenotic superficial femoral artery and popliteal artery（PSV/ PSVpop ） in dagnosis of superficial femoral artery sever stenosis

目的研究彩色多普勒超声检测股浅动脉（SFA）狭窄段与胭动脉的收缩期峰值流速比值（PSV／PSVpop）对SFA重度狭窄（70％～99％）的诊断价值。方法连续纳入SFA狭窄患者185例（234条肢体），记录股浅动脉狭窄段、狭窄近段、胭动脉收缩期峰值流速（PSV、PSVpro、PSVpop），分别计算狭窄段与狭窄近段、远段（胭动脉）的流速比值（PSV／PSVpro、PSV／PSVpop）。以数字减影血管造影（DSA）为金标准，行ROC曲线分析，比较新参数与传统参数的诊断效能。结果新参数PSV／PSVpop≥4诊断SFA70％～99％狭窄，敏感性为96，3％，特异性为91，6％，准确率为94．4％，阳性预测值为95．7％，阴性预测值为91．4％；PSV／PSVpopROC曲线下面积（AUC）为0．978，高于传统参数PSV（0．922）和PSV／PSVpro（0．920），差异均有统计学意义（P〈0．01）。联合PSV与PSV／PSV。预测SFA重度狭窄，准确率高于传统联合参数PSV与PSV／PSV。（94．0％：87．6%），两者AUC差异有统计学意义（0．978：0．940，P〈0．05），但与PSV／PSVpop相比差异无统计学意义（0．978：0．978，P〉0．05）。结论PSV／PSVpop在SFA70％～99％狭窄超声诊断中有重要价值，其诊断效能优于传统血流动力学参数。

Objective To investigate the diagnostic value of PSV/PSVpop, a new parameter detected by color Doppler ultrasonography, for patients with severe stenosis（70 % - 99 % ）in superficial femoral artery （SFA）. Methods One hundred and eighty-five eases （234 limbs） with SFA stenosis detected by CDU and confirmed by DSA were included in this study. Peak systolic velocity of intra-stenotic （PSV）, proximal stenotic （PSVpro）, and popliteal artery （PSVpop） were measured and recorded respectively. The ratio of PSV/PSVpro,PSV/PSVpop were calculated. Using DSA as the gold standard, the cut off values for the diagnosis of severe stenosis were determined with receiver operating characteristics （ROC） analysis. The eSficaey of the above parameters were compared. Results The new parameter PSV/PSVpop≥4 had 96.3% of sensitivity, 91.6 % of specificity, 94.4 % of accuracy, 95.7 % of positive predictive value, and 91.4 % of negative predictive value and 0. 978 of area under the ROC curve（AUC） could define 70% - 99% stenosis of SFA. The AUC of PSV/PSVvop was higher than those of the traditional parameters PSV（0. 922） and PSV/ PSVpro（0. 920）, the difference was statistically significant （P 〈0.01）. The AUC of combined parameter PSV/PSVpop ＋ PSV surpassed conventional combined parameter PSV/PSVpro ＋ PSV （0.978 ： 0.940, P 0.05）, but had no statistically significant difference with single parameter of PSV/PSVpop （0. 978 ： 0. 978, P 〉 0.05）. Conclusions The diagnostic efficacy of PSV/PSVpop is superior to traditional hemodynamic parameters in the diagnosis of SFA severe stenosis.