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肝移植术后肝动脉狭窄的多普勒超声最佳临界值确定及对小慢波患者临床决策作用的研究

连宇帆 郑博文 谭颖仪 童歌 吴涛 郑荣琴 任杰

连宇帆, 郑博文, 谭颖仪, 等. 肝移植术后肝动脉狭窄的多普勒超声最佳临界值确定及对小慢波患者临床决策作用的研究[J]. 器官移植, 2017, 8(1): 54-58. doi: 10.3969/j.issn.1674-7445.2017.01.011
引用本文: 连宇帆, 郑博文, 谭颖仪, 等. 肝移植术后肝动脉狭窄的多普勒超声最佳临界值确定及对小慢波患者临床决策作用的研究[J]. 器官移植, 2017, 8(1): 54-58. doi: 10.3969/j.issn.1674-7445.2017.01.011
Lian Yufan, Zheng Bowen, Tan Yingyi, et al. Determination of optimal threshold for hepatic artery stenosis on Doppler ultrasonography and its effect for clinical decision of treatment for patients with tardus parvus waveform after liver transplantation[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 54-58. doi: 10.3969/j.issn.1674-7445.2017.01.011
Citation: Lian Yufan, Zheng Bowen, Tan Yingyi, et al. Determination of optimal threshold for hepatic artery stenosis on Doppler ultrasonography and its effect for clinical decision of treatment for patients with tardus parvus waveform after liver transplantation[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 54-58. doi: 10.3969/j.issn.1674-7445.2017.01.011

肝移植术后肝动脉狭窄的多普勒超声最佳临界值确定及对小慢波患者临床决策作用的研究

doi: 10.3969/j.issn.1674-7445.2017.01.011
基金项目: 

国家自然科学基金面上项目 81371554

广东省科技计划项目 2013B021800092

广东省自然科学基金研究团队项目 2015A030312013

详细信息
    通讯作者:

    任杰,Email: renjieguangzhou@126.com

  • 中图分类号: R617, R445.1

Determination of optimal threshold for hepatic artery stenosis on Doppler ultrasonography and its effect for clinical decision of treatment for patients with tardus parvus waveform after liver transplantation

More Information
  • 摘要:   目的  分析多普勒超声(DUS)诊断肝移植术后肝动脉狭窄(HAS)的最佳临界值,并结合肝功能异常,提出小慢波(TPW)患者接受CT血管造影(CTA)或数字血管造影(DSA)检查的诊断标准。  方法  收集171例行肝移植术并在术后常规复查DUS、肝功能检查并行CTA或DSA检查确诊患者的临床资料。采用多水平似然比(MLR)确定肝动脉阻力指数(RI)及收缩期加速时间(SAT)诊断HAS的最佳临界值。建立不同诊断标准(低信心类为TPW阳性,中等信心类为TPW阳性+肝功能异常;高信心类为TPW阳性+肝功能异常或TPW阳性+最佳临界值)并比较其诊断效能。  结果  MLR显示诊断HAS的最佳临界值为RI < 0.4,SAT>0.12 s。中等信心类及高信心类诊断标准的特异度明显高于低信心类(P < 0.05),且假阳性率明显降低(P < 0.05)。另外,中等信心类诊断标准的灵敏度明显低于低信心类及高信心类(P < 0.05),而低信心类与高信心类诊断标准间的灵敏度差异无统计学意义(P>0.05)。  结论  对于肝移植术后DUS检查显示TPW阳性的患者,结合肝功能异常及最佳临界值这一诊断标准可帮助临床医师对其作出适当的临床决策。

     

  • 图  1  1例肝移植术后肝动脉狭窄患者的超声图像和DSA显影情况

    本例患者,男性,26岁。肝衰竭行原位肝移植术后约4个月复查,多普勒超声显示肝左动脉RI 0.28,SAT 0.11 s(A图),肝右动脉RI 0.31,SAT 0.11s(B图),肝功能各项指标正常,符合高信心类诊断标准,最后经DSA证实肝动脉吻合口重度狭窄(C图,红色箭头所示),肝内动脉显影浅淡

    Figure  1.  Doppler ultrasonography and DSA of a case with hepatic artery stenosis after liver transplantation

    表  1  肝动脉狭窄及非肝动脉狭窄患者一般情况及DUS检查结果的比较

    Table  1.   Comparison of the general situation and DUS examination results of patients with hepatic artery stenosis and non hepatic artery stenosis

    指标 HAS组
    (n=67)
    非HAS组
    (n=105)
    P
    年龄(岁) 46±10 47±13 0.07
    男性[n (%)] 59 (88) 88 (83.8) 0.51
    小慢波[n (%)] 42 (63) 7(7.7) < 0.01
    最小RI 0.45±0.13 0.62±0.10 < 0.01
    最大SAT (s) 0.11±0.04 0.07±0.02 < 0.01
    下载: 导出CSV

    表  2  多水平似然比分析多普勒超声诊断肝动脉狭窄最佳临界值

    Table  2.   Multi level likelihood ratio analysis on optimal critical value of Doppler ultrasonography in the diagnosis of hepatic artery stenosis

    指标 LR值
    最小RI
    < 0.40 10.58
    0.40~0.50 3.52
    0.51~0.70 0.83
    > 0.70 0.24
    最大SAT (s)
    < 0.06 0.19
    0.06~0.08 0.66
    0.09~0.12 3.70
    > 0.12 16.46
    下载: 导出CSV

    表  3  不同诊断标准的效能比较

    Table  3.   Comparison of efficiency in different diagnosis categories

    标准 灵敏度 特异度 准确度 假阳性率(%)
    低信心类 0.746 0.819 0.791 18.1
    中等信心类 0.418 0.924 0.727 7.6
    高信心类 0.612 0.981 0.837 1.9
    下载: 导出CSV
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出版历程
  • 收稿日期:  2016-10-18
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-01-15

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