卡托普利肾动态显像联合非对比增强磁共振血管成像对肾血管性高血压的诊断价值

Value of non-contrast-enhanced MR angiography combined with captopril renal scintigraphy in the diagnosis of renovascular hypertension

目的探讨卡托普利肾动态显像(CRS)联合非对比增强磁共振血管成像(NCE-MRA)对肾血管性高血压(RVH)的诊断价值。方法回顾性分析河南省人民医院2018年1月至2018年10月间52例被高度怀疑为RVH的患者[男33例,女19例,年龄(54.5±16.3)岁]的NCE-MRA、基础肾动态显像、CRS及肾动脉数字减影血管造影(DSA)检查资料。以DSA提示肾动脉狭窄(RAS)率≥70%作为诊断RVH的标准,分析NCE-MRA、CRS及两者联合诊断RVH的灵敏度、特异性、准确性、阳性预测值(PPV)和阴性预测值(NPV)。NCE-MRA与DSA诊断RVH的一致性采用Kappa检验,联合诊断与CRS单独诊断的效能比较采用χ^2检验或Fisher确切概率法。结果NCE-MRA与DSA诊断RVH的一致性较好(Kappa=0.81,95%CI:0.62~0.96;P<0.01)。NCE-MRA诊断RVH的灵敏度、特异性、准确性、PPV及NPV分别为88.89%(24/27)、92.00%(23/25)、90.38%(47/52)、92.31%(24/26)及88.46%(23/26);CRS诊断RVH的相应效能指标分别为81.48%(22/27)、72.00%(18/25)、76.92%(40/52)、75.86%(22/29)及78.26%(18/23);NCE-MRA联合CRS的诊断效能指标分别为74.07%(20/27)、100%(25/25)、86.54%(45/52)、100%(20/20)和78.12%(25/32),与CRS单独诊断比较,联合诊断的特异性(P=0.01)、PPV(P=0.03)均提高。结论NCE-MRA及CRS是诊断RVH有效的初筛手段,且两者联合应用能较CRS单独检查明显提高RVH诊断的特异性及PPV。

Objective To evaluate the clinical value of non-contrast-enhanced MR angiography(NCE-MRA)combined with captopril renal scintigraphy(CRS)in the diagnosis of renovascular hypertension(RVH).Methods A total of 52 patients(33 males,19 females;age:(54.5±16.3)years)with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People′s Hospital were retrospectively analyzed.The examination data of NCE-MRA,basic renal dynamic imaging,CRS and digital subtraction angiography(DSA)were collected and reviewed.The renal artery stenosis(RAS)rate≥70%was the criterion for RVH diagnosed by DSA,which was considered as the gold standard.The diagnostic sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)of NCE-MRA,CRS and NCE-MRA+CRS were determined.The consistency between NCE-MRA and DSA was analyzed by Kappa test.The differences of diagnostic efficiencies between CRS and NCE-MRA+CRS were compared byχ^2 test or Fisher exact test.Results There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH(Kappa=0.81,95%CI:0.62-0.96;P<0.01).The diagnostic sensitivity,specificity,accuracy,PPV and NPV of NCE-MRA were 88.89%(24/27),92.00%(23/25),90.38%(47/52),92.31%(24/26),and 88.46%(23/26)respectively,those of CRS were 81.48%(22/27),72.00%(18/25),76.92%(40/52),75.86%(22/29)and 78.26%(18/23)respectively,and those of NCE-MRA+CRS were 74.07%(20/27),100%(25/25),86.54%(45/52),100%(20/20)and 78.12%(25/32)respectively.Compared with CRS,the specificity(P=0.01)and PPV(P=0.03)of NCE-MRA+CRS in the diagnosis of RVH were increased.Conclusion NCE-MRA and CRS are effective in the diagnosis of RVH,and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone.