超声监测肱动脉血管参数对自体动静脉内瘘并发症的诊断价值

Diagnostic value of ultrasonic monitoring of brachial artery vascular parameters for autologous arteriovenous fistula complications

目的探讨超声监测肱动脉血管参数对自体动静脉内瘘并发症的诊断价值。方法回顾性分析2016年3月至2020年6月于南京大学医学院附属鼓楼医院超声科行自体动静脉内瘘检查的106例慢性肾脏病患者的超声影像资料,根据超声检查有无常见并发症(头静脉血栓、头静脉狭窄、头静脉瘤样扩张),分为无并发症组(n=57)与常见并发症组(n=49);常见并发症组包括:头静脉血栓组(8例),头静脉狭窄组(31例),头静脉瘤样扩张组(21例),其中10例患者同时发生两种及两种以上的并发症。分析各组超声监测肱动脉内径、收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)、时间平均流速(TAMV)、搏动指数(PI)以及流量参数,比较各组间肱动脉血管参数的差异,绘制受试者工作特征(ROC)曲线,比较各参数对头静脉狭窄的诊断价值。结果无并发症组肱动脉PSV[(149.42±41.95)cm/s]、EDV[(71.75±23.62)cm/s]、TAMV[(59.25±19.79)cm/s]、流量[(898.26±357.09)ml/min]均高于常见并发症组[(128.91±40.42)cm/s,(56.19±29.98)cm/s,(46.82±23.69)cm/s,659.00(291.50,934.50)ml/min],均差异有统计学意义(t=2.55,2.99,2.94;Z=-2.60;均P<0.05)。无并发症组PI[1.38(1.13,1.61)]低于常见并发症组[1.52(1.11,2.40)],差异具有统计学意义(Z=2.13,P<0.05)。肱动脉内径、PSV、EDV、RI、PI、TAMV及流量对头静脉狭窄诊断的ROC曲线下面积分别为0.71、0.73、0.76、0.70、0.68、0.75、0.81;特异度分别为68.42%、75.44%、91.23%、89.47%、92.98%、92.98%、91.23%;敏感度分别为67.74%、64.52%、54.84%、48.39%、51.61%、54.84%、61.29%(均P<0.01)。结论超声监测肱动脉血管参数对自体动静脉内瘘并发症有一定的诊断价值,肱动脉流量对头静脉狭窄的诊断价值最大。

Objective To explore the diagnostic value of brachial artery vascular ultrasound inspection for autologous arteriovenous fistula(AVF)complications.MethodsRetrospective analysis of ultrasound imaging data was applied to 106 patients with chronic kidney disease undergoing AVF in the Ultrasonic Department of Drum Tower Hospital Affiliated to Medical School of Nanjing University from March 2016 to June 2020.Patients were divided into non-complication group(n=57)and common complication group(n=49)according to ultrasound examination results.The latter was further divided into cephalic venous thrombosis group(n=8),cephalic venous stenosis group(n=31)and cephalic venous aneurysm-like dilatation group(n=21),according to the type of complications,10 patients had two or more complications.The diameter,peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),time-averaged mean velocity(TAMV),pulsatility index(PI),and blood flow of brachial artery were measured by ultrasound.The parameters of brachial artery were compared between groups,and the diagnostic value for cephalic vein stenosis was analyzed by receiver operating characteristic(ROC)curve.ResultsThe PSV[(149.42±41.95)cm/s],EDV[(71.75±23.62)cm/s],TAMV[(59.25±19.79)cm/s],blood flow[(898.26±357.09)ml/min]of brachial artery in non-complication group were higher than those of common complication group[(128.91±40.42)cm/s,(56.19±29.98)cm/s,(46.82±23.69)cm/s,659.00(291.50,934.50)ml/min],with significant differences(t=2.55,2.98,2.94,Z=-2.60,all P<0.05).PI[1.38(1.13,1.61)]in non-complication group was lower than that of the common complication group[1.52(1.11,2.40)],with significant difference(Z=2.13,P<0.05).The areas under the ROC curve of brachial artery diameter,PSV,EDV,RI,PI,TAMV and blood flow for the diagnosis of cephalic venous stenosis were 0.71,0.73,0.76,0.70,0.68,0.75,0.81.Specificities were 68.42%,75.44%,91.23%,89.47%,92.98%,92.98%,91.23%,while sensibilities were 67.74%,64.52%,54.84%,48.39%,51.61%,54.84%,61.29%(all P<0.01).ConclusionUltrasound monitoring of brachial artery vascular parameters has certain diagnostic value for AVF complications,and the brachial artery flow has the greatest diagnostic value for cephalic venous stenosis.