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多普勒超声对股浅动脉支架术后再狭窄的预测价值
The predictive value of duplex ultrasound in SFA in-stent restenosis

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DOI:
作者:
谢辉
XIE Hui
作者单位:
上海交通大学医学院附属仁济医院血管外科
Renji Hospital ，Shanghai Jiao Tong University School of Medicine
关键词:
股浅动脉 支架内再狭窄 双功彩超
superficial femoral artery (SFA)；in-stent restenosis；duplex ultrasound(DU)
摘要:
目的 通过回顾分析股浅动脉支架内再狭窄的动脉造影和双功彩超资料，评价双功彩超（Duplex ultrasound ，DU）对股浅动脉支架内再狭窄的预测价值。方法 对接受股浅动脉支架植入治疗的96例患者（共112条肢体）进行双功彩超随访，记录支架近端3cm无病变区收缩期峰值流速（proximal velocity，Vp）和支架内收缩期峰值流速（peak systolic velocity，PSV），并计算PSV与Vp比值（peak systolic velocity ratio，PSVR）。对下肢缺血症状复发和怀疑存在支架内再狭窄的患者行动脉造影检查，并完成双功彩超和血管造影资料的配对。使用SPSS17.0、MEDCALC 11.6.1.0软件，将动脉造影支架内狭窄率同PSV、PSVR进行直线回归和ROC曲线统计学分析，从而探寻PSV、PSVR与支架内再狭窄的关系，评价DU对股浅动脉支架内再狭窄的预测价值。结果 PSV和PSVR均与动脉造影支架内狭窄率存在强烈的线性相关（R2 = 0.83, P < .001 和 R2=0.76, P < 0.001)。ROC 曲线显示当动脉造影支架内狭窄率>50%时，其PSV>165cm/s，（敏感度95.5%，特异度97.8%，阳性预测值98.4%，阴性预测值93.7%，ROC曲线下面积0.994），PSVR>1.90（敏感度90.9%，特异度100%，阳性预测值 100%，阴性预测值88.5%，ROC曲线下面积0.979）。当动脉造影支架内狭窄率>80%，其PSV>285cm/s，（敏感度94.1%，特异度99%，阳性预测值94.1%，阴性预测值98.9%，ROC曲线下面积0.980），PSVR>2.7（敏感度94.1%,特异度90.5%，阳性预测值 64%，阴性预测值98.9%，ROC曲线下面积0.973）。支架内再狭窄率>50%时，PSV和PSVR的ROC曲线下面积无明显差异（P=0.2178>0.05）。支架内再狭窄率>80%时，PSV和PSVR的ROC曲线下面积无明显差异（P=0.9663>0.05）。结合PSV>285cm/s和PSVR>2.7预测支架内再狭窄率>80%，其敏感度94.1%，特异度97.9%，阳性预测值88.9%，阴性预测值98.9%。结论 PSV和PSVR可以有效地预测支架内再狭窄。联合PSV>285cm/s和PSVR>2.70，对诊断支架内再狭窄率>80%具有更高的可靠性。
Objective The goal of this study is to determine the utility of duplex scanning to detect angiographic in-stent restenosis after endovascular therapy in patientswith superficial femoral artery (SFA) disease. Method A retrospect including 96 patients（112 legs） treated for SFA occlusion disease between June 2009 and March 2011 was performed. Patients were followedup with duplex ultrasound. Peak systolic velocity ratio (PSVR) were calculated for each lesion by dividing the in-stent peak systolic velocity (PSV) within the lesion by the peak velocity proximal to the lesion. Patients received angiograms when the symptoms reccured or suspected of in-stent restenosis by duplex data .Paired the data of angiograms and duplex ultrasound .Linear regression and receiver operator characteristic(ROC) curve analyses were used. Results Mean follow-up was 13.9±3.6months. Linear regression models of PSV and PSVR vs degree of angiographic stenosis showed strong adjusted correlation coefficients (R2 = 0.83, P < .001 and R2=0.76, P < 0.001, respectively). ROC curve analysis showed that to detect a >50% in-stent stenosis, a PSV >165cm/s had 95.5%sensitivity, 97.8% specificity, a 98.4% positive predictive value (PPV),a 93.7% negative predictive value(NPV) ,and a 0.994 area under the ROC curve (AUC) ; for PSVR, aratio of >1.90 had 90.9% sensitivity, 100% specificity, a 100% PPV, and a 88.5% NPV, and a0.979AUC. To detect >80% in-stent stenosis, a PSV>285 had 94.1% sensitivity, 99% specificity, a 94.1% PPV, a 98.9% NPV, and a 0.980 AUC; a PSVR >2.7 had 94.1% sensitivity, 90.5%specificity, a 64% PPV, a 98.9% NPV, and a 0.973AUC.Combining a PSV >285cm/s and a PSVR >2.70 to determine >80% in-stent stenosis had94.1% sensitivity, 97.9% specificity, a 88.9% PPV, and a 98.9% NPV. To detect a >50% in-stent stenosis there is no significant difference between the AUC of PSV and PSVR（P=0.2178>0.05） . To detect a >80% in-stent stenosis there is no significant difference between the AUC of PSV and PSVR（P=0.9663>0.05）.Conclusion PSV and Vr appear to have a significant role in predicting in-stent stenosis. To determine >80% stenosis,combining PSV >285 cm/s and Vr >2.70 is highly specific and predictive.

 

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