高频超声成像评估中青年下肢静脉曲张及危险因素

Risk Factor and Evaluation of Lower Extremity Varicose Veins in Young and Middle-Aged People via High-Frequency Ultrasound

目的应用高频超声成像技术对中青年下肢静脉曲张(LEVV)严重程度及危险因素进行分析,为术前评估提供临床依据。资料与方法回顾性分析2018年3月—2021年11月空军军医大学第一附属医院确诊的278例中青年(年龄≤45岁)LEVV患者的临床及超声影像学资料,根据临床-病因-解剖学-病理生理分级标准将患者分为轻症组78例及干预组200例,分析患者的发病特点,比较两组患者下肢静脉血流动力学特征,采用Logistic回归分析影响中青年LEVV患者病程进展的危险因素。结果中青年LEVV男性居多(60.4%,168/278),右侧多见[右侧87.1%(242/278)比左侧68.0%(189/278);χ^(2)=28.989,P<0.001]。与轻症组比较,干预组有代谢异常或类风湿病史(χ^(2)=4.711,P=0.030)、长期低温暴露史(χ^(2)=10.352,P=0.001)及家族史(χ^(2)=4.833,P=0.028)比例较高。Logistic回归分析显示,代谢异常或类风湿病史(OR=3.576,95%CI 1.177~10.863)及长期低温暴露史(OR=2.409,95%CI 1.347~4.309)是中青年LEVV进展加重的危险因素,久坐(OR=0.371,95%CI 0.197~0.699)是中青年LEVV轻症发生的危险因素。与轻症组比较,干预组右侧大隐静脉和小隐静脉血管内径明显增宽(t=4.280、3.055,P<0.05)。结论中青年LEVV好发于男性,右侧多见,代谢异常或类风湿病史及长期低温暴露史是诱发中青年LEVV加重的危险因素。进展期及重症患者常合并右侧浅静脉血管内径明显增宽。超声医师应加强对LEVV病程的认识,早期积极干预以改善预后。

Purpose To analyze the severity and risk factors in young and middle-aged patients with varicose veins of lower extremity(LEVV)via high frequency ultrasonography technology,and provide clinical basis for preoperative evaluation.Materials and Methods A total of 278 young and middle-aged patients with LEVV(age≤45 years old)were diagnosed in the First Affiliated Hospital of Air Force Medical University from March 2018 to November 2021,the clinical and ultrasound imaging data were analyzed retrospectively.All patients were divided into conservative group(n=78)and intervention group(n=200)according to the clinical etiology anatomy pathophysiology grading standard.The hemodynamic characteristics of lower extremities venous were compared between the two groups,and Logistic regression model was used to analyze the risk factors affecting the progression of LEVV in young and middle-aged patients.Results Of all patients,there were mostly males in young and middle-aged LEVV patients(60.4%,168/278),and the right leg was more affected than the left leg[right 87.1%(242/278)vs.left 68.0%(189/278);χ^(2)=28.989,P<0.001].There were significant differences in metabolic abnormalities or rheumatoid disease history(χ^(2)=4.711,P=0.030),long-term hypothermia exposure history(χ^(2)=10.352,P=0.001)and family history(χ^(2)=4.833,P=0.028)between the two groups.Logistic regression showed that metabolic disorder or rheumatoid disease history(OR=3.576,95%CI 1.177-10.863)and long-term low temperature exposure(OR=2.409,95%CI 1.347-4.309)were the risk factors for the progression of LEVV in young and middle-aged population,sedentary(OR=0.371,95%CI 0.197-0.699)was the risk factor for conservative young and middle-aged people with LEVV.The inner diameter of the right superficial vein in the intervention group was significantly higher than that in the mild group(t=4.280,3.055,P<0.05).Conclusion Young and middle-aged LEVV is more common in males,and occurs on the right side.History of metabolic abnormalities or rheumatoid and long-term low temperature exposure are the risk factors for LEVV aggravation.For progression and severe patients,the inner diameter of the right superficial vein is often enlarged significantly.Doctors should strengthen their understanding on LEVV and improve prognosis with early intervention.