目的：探讨儿童胡桃夹现象（NCP）的超声诊断标准。方法对以不明原因的血尿或蛋白尿为主要临床症状的NCP（NCP组，33例）和无NCP患儿（nonNCP组，13例）采用超声测量左肾静脉（LRV）受压前扩张段（a段）内径（φa）与受压段（b段）前后径（φb）及其比值（φa／φb）、a段肾静脉血流峰值流速（Vmax‐a）及b段肾静脉血流峰值流速（Vmax‐b）、左右两侧肾门处肾静脉血流峰值流速（Vmax‐l ，Vmax‐r），计算φa／φb、Vmax‐l／Vmax‐r和Vmax‐b／Vmax‐a比值。比较两组平卧体位及脊柱后伸位时相关指标的差异。绘制受试者工作特征（ROC ）曲线，分析诊断 NCP的特异度和敏感度。结果平卧位，NCP组φa／φb比值大于nonNCP组（4.37±1.58 vs ．2.21±0.38）（P＜0．01）。NCP组Vmax‐b和 Vmax‐b／Vmax‐a 比值大于 nonNCP 组[（136.22±44.12） cm／s vs ．（63.88±29.11）cm／s和7.27±2.82 vs ．3.05±1.52]（P＜0．01）。NCP组的Vmax‐r大于nonNCP组[（28.37±6.34） cm／s vs ．（23.72±4.56） cm／s]，但 Vmax‐l／Vmax‐r比值小于nonNCP组（0.73±0.20 vs ．0.87±0.14）（ P＜0．05）。而两组的 Vmax‐a和 Vmax‐l差异无统计学意义（ P＞0．05）。平卧位取φa／φb界值2.75，诊断NCP的特异度为100％，敏感度为87.88％；脊柱后伸位取φa／φb界值3.95，诊断NCP的特异度100％，但敏感度只有66.67％。结论彩色多普勒超声在诊断儿童NCP的标准可采用平卧位φa／φb比值＞2.75，同时结合Vmax‐b＞100 cm／s和Vmax‐b／Vmax‐a比值＞5.5来综合判断。%Objective To investigate the ultrasound criteria for the diagnosis of nutcracker phenomenon(NCP) in children .Methods Ultrasound measurements were performed in 33 children (group NCP) with NCP manifested by unexplained hematuria and proteinuria and 13 children(group nonNCP) without NCP .The criteria measured included the inner diameter (φa) of dilated section (a section) ahead of compressed left renal vein (LRV ) and the anteroposterior diameter (φb ) of compressed part(b section) of LRV ,the blood flow peak velocity of a section(Vmax‐a) and b section (Vmax‐b) ,the blood flow peak velocity of both sides renal vein(RV) at the renal hilus(Vmax‐l and Vmax‐r) .The ratios of φa to φb ,Vmax‐l to Vmax‐r and Vmax‐b to Vmax‐a were calculated .The differences of the criteria between two positions of supine and stretch extending of the spine were compared .Receiver‐operating characteristic(ROC) curve was mapped and specificity and sensitivity were analyzed .Results On the supine position ,φa/φb ratio was higher in group NCP than that in group nonNCP(4.37 ± 1.58 vs .2.21 ± 0.38)(P<0 .01) .The Vmax‐b and Vmax‐b/Vmax‐a ratio were higher in group NCP than those in group nonNCP[(136.22 ± 44.12) cm/s vs .(63.88 ± 29.11) cm/s and 7.27 ± 2.82 vs .3.05 ± 1.52](P<0 .01) .The Vmax‐b was higher ,but Vmax‐b/Vmax‐a ratio was lower ,in group NCP than those in group nonNCP[(28.37 ± 6.34) cm/s vs .(23.72 ± 4.56) cm/s and 0.73 ± 0.20 vs .0.87 ± 0.14](P<0 .05) .But Vmax‐a and Vmax‐l were not significantly different between two groups(P>0 .05) .Taking φa/φb 2.75 as the cutoff value on supine position , the specificity and sensitivity for the diagnosis of NCP were 100% and 87.88% ,respectively .Takingφa/φb 3.95 as the cutoff value on the position of spine stretch extending ,the specificity and sensitivity for the diagnosis of NCP were 100% and 66.67% ,respectively .Conclusion Theφa/φb ratio > 2.75 combined use of Vmax‐b>100 cm/s and Vmax‐b/Vmax‐a ratio >5.5 can be taken as a ultrasound criterion for the diagnosis of NCP in children .
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