correlation between venous insufficiency and valve function in deep vein thrombosis

应用近红外光谱(NIRS)对慢性静脉功能不全(CVI)患者的动态静脉功能进行评价。研究对象为原发性静脉曲张患者和四肢正常的志愿者。根据患者的临床症状和体征将患者的患肢分为三组。所有患者都接受了跑步机步行试验，并在此期间应用了NIRS。在运动过程中用近红外光谱仪连续测定氧合血红蛋白(OxyHb)和脱氧血红蛋白(DeoHb)。比较4组(正常组、轻、重度CVI组)动态静脉滞留指数(Avri)。观察到两种截然不同的DeoHb变化模式。在运动过程中，由于小腿肌肉收缩，正常组的DeoHb水平下降，而在静脉曲张组，DeoHb水平下降。DeoHb水平升高是因为明显的静脉回流进入小腿肌肉。AVRI研究演示…组间比较差异有统计学意义(p&lt；0.001)。NIRS有助于准确评估原发性静脉曲张患者的动态静脉功能障碍。为了确定血栓影响的部位对后续静脉生理的影响，我们使用NIR检查了血栓后综合征(PTS)患者的动态静脉功能。研究对象是自深静脉血栓(DVT)急性发作以来已超过一年的患者。PTS的平均病程为8.2年。所有患者均进行跑台步行，避免同时出现NIR。运动过程中连续测定DeoHb。在每个患者中计算从系列DeoHb变化中获得的Avri。通过静脉造影确定血栓在DVT发生时的位置。计算的AVRI值与PTS的临床症状有明显的相关性，发病肢体的AVRI值明显高于无静脉血栓形成的肢体。PTS的临床严重程度与运动时静脉滞留的程度密切相关。为探讨NIRS对深静脉血栓的诊断价值，并与空气容积描记(APG)相比较，对临床疑似深静脉血栓的患者进行了研究。所有患者均接受静脉造影和APG检查，患者还接受了同步NIR的跑台步行试验，计算每个患者由系列DeoHb变化获得的Avri。NIRS和APG的总敏感性分别为97%和80%。NIRS较APG更敏感(分别为89%和22%)，而NIRS和APG均可发现所有肢体的近端DVT。NIRS是诊断血流动力学有意义的DVT的一种高度敏感的方法。较少

Patients with chronic venous insufficiency (CVI) were evaluated from the aspect of ambulatory venous function using near-infrared spectroscopy (NIRS). Patients with primary varicose veins and volunteers with normal limbs were studied. The affected limbs of the patients were divided into three groups according to their clinical signs and symptoms. All of the patients underwent a treadmill walking test, during which NIRS was applied. Oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoHb) were continuously measured by NIRS during exercise. The ambulatory venous retention index (AVRI) obtained from serial changes in DeoHb was assessed comparatively in the four groups (normal and mild to severe CVI). Two distinct patterns of DeoHb change were observed. During exercise, the DeoHb level decreased in the normal group due to calf muscle contraction, whereas, in the varicose group, . the DeoHb level rose because of an apparent venous reflux into the calf muscles. AVRI studies demonstr … More ated a significant difference (p<O.OOOl) among groups. NIRS is useful for accurately assessing ambulatory venous dysfunction in patients with primary varicose veins.To determine the influence of the site affected by thrombi on the subsequent venous physiology, we examined patients with post-thrombotic syndrome (PTS) with respect to ambulatory venous function using NIRS.Patients, in whom more than one year had passed since an acute episode of deep vein thrombosis (DVT), were studied. The mean duration of PTS was 8.2 years. All of the patients underwent a treadmill walking lest with simultaneous NIRS.DeoHb was continuously measured during exercise. The AVRI obtained from the serial DeoHb changes was calculated in each patient. The location of thrombi at the onset of DVT was identified by venography. The calculated AVRI was apparently related to the clinical symptoms of PTS.The limbs initially involved with popliteal vein thrombosis showed significantly higher AVRI values than those without popliteal vein thrombosis. The clinical severity of PTS is correlated well with the degree of venous retention during exercise. Initial involvement of the popliteal vein is an important factor determining subsequent venous hemodynamics in patients with PTS.To investigate the diagnostic value of NIRS for the detection of DVT, particularly isolated calf DVT, in comparison with air plethysmography (APG), patients with clinically suspected DVT were studied. All patients were examined by venography and APG.Patients also underwent a treadmill-walking test with simultaneous NIRS.The AVRI obtained from serial DeoHb changes was calculated in each patient. Tue overall sensitivity of NIRS and APG was 97% and 80%0, respectively. NIRS was more sensitive than APG for detecting isolated calf DVT (89% and 22%, respectively), while both tests identified proximal DVT in all limbs. NIRS is a highly sensitive method for the diagnosis of hemodynamically significant DVT. Less