彩色多普勒超声在肾动脉狭窄诊断中的临床应用

Color doppler ultrasound application in renal artery stenosis research

目的探讨彩色多普勒超声在肾动脉狭窄诊断中的临床应用价值。方法收集经临床医生初步诊断为药物难治性高血压(尤以舒张压增高为主)的患者60例,共119支肾动脉。在肾动脉条件下首先观察肾动脉主干有无狭窄所致的花色血流信号,初步判断狭窄的部位;再测量肾动脉水平部腹主动脉,花色血流信号处,肾动脉主干近、中、远段及肾内段,叶间动脉的血流参数;同时采集肾内叶间动脉频谱声像图,测量各动力学参数。依据彩色多普勒超声(CDFI)检查成功的标准,按内径减少百分比得出肾动脉狭窄程度,同期行肾动脉血管造影。将CDFI检查的肾动脉狭窄程度与"金标准"血管造影(DSA)结果相对比。结果彩色多普勒测量不同狭窄组患者各血流动力学参数呈明显改变:CDFI诊断肾动脉狭窄的敏感性92.5%、特异性95.0%,符合率94.2%;轻度狭窄的敏感性100.0%,特异性97.1%;中度狭窄的敏感性85.7%,特异性100.0%;重度狭窄的敏感性96.2%,特异性90.9%。结论 CDFI为诊断肾动脉狭窄提供了简便、准确的影像学检查方法,进一步为临床选择合理的治疗方法提供了可靠依据。

Objective To explore the applied research of Color Doppler ultrasound in renal artery stenosis. Methods There are 60 cases and total of 119 renal are preliminarily diagnosed as the clinical drug-refractory renovascular hypertension. Color Doppler was used to observe whether the colorful blood flow signals could caused by the renal artery stenosis,and preliminarily determine the stenosis location. The spectral Doppler sonographic,the blood flow parameters of renal artery abdominal aortic,the location of colorful blood flow signal,the near,middle and far sections,segment artery and interlobar artery of renal artery were measured. Through above measurements of PSV,AT,AC,RI,RPSV,RAR and RIR; were calculated. Through application of various blood fluid mechanics parameters along with spectral shape changes and CDFI criteria,the location and severity of renal artery stenosis were determined. Comparing Doppler ultrasound results in renal artery stenosis severity with the renal artery angiographic results. Results Renal artery Color doppler ultrasound diagnosis of renal artery stenosis had a sensitivity of 92. 5% and a specificity of 95. 0%. Diagnosis of renal artery stenosis severity： Stenosis severity 50% had a sensitivity of 100% and a specificity of 97. 1%; moderate stenosis had a sensitivity of 85.7% and a specificity of 100%; severe stenosis had a sensitivity of 96. 2% and a specificity of 90. 9%. Conclusions Color Doppler ultrasound provides a more accurate imaging assistance examinations for the renal artery stenosis; and also provide a more reliable basis to select the appropriate clinical treatment.