超声造影评价老年肾动脉狭窄患者的临床价值

摘要

目的 探讨超声造影诊断肾动脉狭窄(RAS)的应用价值. 方法 前瞻性研究,纳入2017年1-12月在北京医院肾内科住院治疗的慢性肾脏病2～3期临床可疑且经CTA确诊的20例中老年RAS患者,对其40条肾动脉行肾动脉常规超声及超声造影检查,将常规超声与超声造影(CEUS)结果分别与数字剪影血管造影(DSA)结果对比,分析两种检查方法的一致性. 结果 20例RAS患者巾,男性12例,女性8例,平均年龄(65±5)岁,均有高血压病史.常规超声诊断RAS 12条血管(轻度6条,中度4条,重度2条).超声造影检诊断RAS 17支(轻度8条,中度6条,重度3条).血管造影后确诊RAS 19条血管(轻度9条,中度7条,重度3条).常规超声与血管造影诊断RAS的吻合度(Kappa=0.77)低于超声造影与血管造影诊断RAS的吻合度(Kappa=0.96,P＜0.01).超声造影诊断轻度、中度、重度RAS的准确率分别为88.9％、94.1％和1oo.0％. 结论 超声造影较常规超声更清楚显示肾动脉,与DSA检查RAS具有较高的一致性.%Objective To explore the clinical value of the contrast-enhanced ultrasound (CEUS) in the diagnosis of renal artery stenosis(RAS).Methods A total of 20 patients(12 males and 8 females) including 40 renal arteries,who were suspected to have RAS were enrolled in Department of Renal,Beijing Hospital.All patients were examined by color doppler ultrasound,CEUS and digital subtraction angiography (DSA).The results of conventional ultrasound and CEUS were compared with the DSA results,respectively.Results All patients had history of hypertension,aged (65 ± 5)years.12 branches (mild 6,moderate 4,severe 2) were RAS by regular ultrasound,17 branches (mild 8,moderate 6,severe 3)were RAS by by CEUS,while 19 branches (mild 9,moderate 7,severe 3) were diagnosed as RAS by DSA.The measure of agreement Kappa between conventional ultrasound and DSA was lower than that between CEUS and DSA (0.77 vs.0.96,P＜0.01).The diagnostic accuracy of mild,moderate and sever RAS with CEUS were 88.9％,94.1％ and 100％,respectively.Conclusions CEUS shows the renal artery more clearly than conventional ultrasound,and has a high consistency with DSA in the diagnosis of RAS.