RENAL DUPLEX SONOGRAPHY - EVALUATION OF CLINICAL UTILITY
RENAL DUPLEX SONOGRAPHY - EVALUATION OF CLINICAL UTILITY
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DOI：
10.1067/mva.1990.22791
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发表时间：
1990-09-01
影响因子：
4.3
通讯作者：
DEAN, RH
中科院分区：
文献类型：
--
作者：
HANSEN, KJ;TRIBBLE, RW;DEAN, RH
除了传统的血管造影术，没有以前提出的筛选试验具有必要的敏感性/特异性，以指导进一步评价可纠正的肾血管疾病。最近，肾双功超声检查已被建议作为一个有用的替代，这样的筛选肾血管疾病。本报告分析我们过去十个月来收集的资料，以评估肾脏双功能超音波的诊断价值。肾脏双功超声检查有效性分析的研究人群包括74名连续患者，这些患者对148个肾脏的动脉解剖结构进行了77项比较性肾脏双功超声检查和标准血管造影研究。6个肾脏（4%）的肾脏双功超声检查结果被认为不足以解释。该研究人群包括26例重度肾功能不全（平均3.6 mg/dl）患者（35%）和67例高血压患者（91%）。14例患者（19%）有20个肾脏，有多个肾动脉。44例显著肾血管疾病患者中有22例存在双侧疾病。在44例经血管造影证实病变的患者中，肾双功超声检查正确识别了41例肾血管疾病的存在，在任何无疾病的患者中均未识别出肾血管疾病。当单肾动脉存在时（122个肾脏），肾脏双功超声检查提供了93%的灵敏度，98%的特异性，98%的阳性预测值，94%的阴性预测值，和96%的总体准确性。当检查具有多个（极）肾动脉的肾脏时，这些结果受到不利影响。尽管舒张末期比值与血清肌酐呈负相关（r=-0.3073，p = 0.009），但35例接受肾血管重建的患者的舒张末期比值较低并不排除有益的血压或肾功能反应。我们的结论是，从这个分析，肾双功超声检查可以是一个有价值的筛选试验，在寻找可纠正的肾血管疾病引起的全肾缺血和继发性肾功能不全（缺血性肾病）。然而，肾双功超声检查不能排除单独引起高血压的极血管肾血管疾病，也不能预测高血压或肾血管疾病纠正后的肾功能反应。（J VASCSurg1990;12：227-36.）
With the exception of conventional angiography, no previously proposed screening test has the necessary sensitivity/specificity to guide further evaluation for correctable renovascular disease. Recently, renal duplex sonography has been suggested as a useful substitute in such screening for renovascular disease. This report analyzes our data collected over the past 10 months in evaluation of renal duplex sonography to examine its diagnostic value. The study population for renal duplex sonography validity analysis consisted of 74 consecutive patients who had 77 comparative renal duplex sonography and standard angiographic studies of the arterial anatomy to 148 kidneys. Renal duplex sonography results from six kidneys (4%) were considered inadequate for interpretation. This study population contained 26 patients (35%) with severe renal insufficiency (mean 3.6 mg/dl) and 67 hypertension (91%). Fourteen patients (19%) had 20 kidneys with multiple renal arteries. Bilateral disease was present in 22 of the 44 patients with significant renovascular disease. Renal duplex sonography correctly identified the presence of renovascular disease in 41 of 44 patients with angiographically proven lesions, and renovascular disease was not identified in any patient free of disease. When single renal arteries were present (122 kidneys), renal duplex sonography provided 93% sensitivity, 98% specificity, 98% positive predictive value, 94% negative predictive value, and an overall accuracy of 96%. These results were adversely affected when kidneys with multiple (polar) renal arteries were examined. Although the end diastolic ratio was inversely correlated with serum creatinine (r= −0.3073,p= 0.009), low end diastolic ratio in 35 patients submitted to renovascular reconstruction did not preclude beneficial blood pressure or renal function response. We conclude from this analysis that renal duplex sonography can be a valuable screening test in the search for correctable renovascular disease causing global renal ischemia and secondary renal insufficiency (ischemic nephropathy). Renal duplex sonography does not, however, exclude polar vessel renovascular disease causing hypertension alone nor does it predict hypertension or renal function response after correction of renovascular disease. (J VASCSURG1990;12:227-36.)