摘要
目的:评价双臂间收缩压差(IASBPD)联合脉搏容积图(PVR)衍生参数诊断锁骨下动脉狭窄的价值。方法:回顾性连续收集2017年10月至2018年10月在中国医学科学院阜外医院五病区诊断为弓上动脉狭窄的住院患者的临床资料。这些患者均先行同步四肢血压和脉搏波测量,随后在3~5天内完成选择性弓上动脉造影。以造影显示锁骨下动脉直径狭窄≥50%作为诊断金标准,运用ROC曲线计算IASBPD、PVR的脉搏波上行时间(UT)和脉搏波上行时间占比(UTCC)诊断锁骨下动脉狭窄的最佳切点,并分析IASBPD联合UT或UTCC的诊断价值。结果:共纳入320例患者(640条锁骨下动脉),年龄39~84(64.3±8.5)岁,男性248例(77.5%)。135例(42.2%)患者锁骨下动脉狭窄≥50%,其中双侧狭窄34例(25.2%)。IASBPD、UT和UTCC的ROC曲线下面积分别为0.84、0.76和0.80(P均<0.001),诊断锁骨下动脉狭窄的最佳切点分别为9 mmHg(1 mmHg=0.133 kPa)、202 ms和23.2%。以切点作标准,IASBPD诊断锁骨下动脉狭窄的敏感度和特异度分别为57.0%和94.1%。UT与UTCC诊断锁骨下动脉狭窄的敏感度一致(72.6%vs.72.6%,P>0.05),但UTCC的特异度更高(72.4%vs.81.1%,P<0.05)。相比IASBPD单一指标,IASBPD联合UT或UTCC的敏感度均增高(P均<0.001),分别为85.2%和78.5%(P>0.05),特异度降低(P均<0.001),分别为67.6%和76.8%(P<0.05)。结论:IASBPD联合PVR衍生参数UT或UTCC是筛查锁骨下动脉狭窄的有效方法,可显著提高诊断的敏感度。
Objectives:To evaluate the efficiency of inter-arm systolic blood pressure difference(IASBPD)combined with pulse volume recording(PVR)parameters for screening patients with subclavian stenosis(SS).Methods:Consecutive patients with supra-arch artery stenosis,who hospitalized from October 2017 to October 2018 at Fuwai hospital,were enrolled.All patients underwent simultaneous four-limb blood pressure measurements and pulse volume recording,followed by selective subclavian artery angiography within 3-5 days.Subclavian artery diameter reduction≥50%by angiography was defined as the gold standard of SS.The receiver operating characteristic(ROC)curve was used to calculate the optimal cut-off value and diagnostic efficiency of IASBPD,upstroke time(UT)and upstroke time per cardiac cycle(UTCC)of PVR.The diagnostic efficacy of IASBPD combined with PVR for screening SS was further analyzed.Results:320 consecutive patients(640 subclavian arteries)were enrolled.248 patients(77.5%)were male,mean age was(64.3±8.5)years.SS were detected in 135 patients(42.2%),bilateral SS were detected in 34 patients(25.2%).The optimal cut-off value of IASBPD,UT and UTCC for diagnosing SS were 9 mmHg,202 ms and 23.2%,respectively,AUC was 0.84,0.76 and 0.80,respectively(all P<0.001).The sensitivity and specificity were 57.0%and 94.1%by IASBPD.Sensitivity by UT and UTCC was similar(72.6%vs.72.6%,P>0.05),but specificity was significantly higher by UTCC than by UT(81.1%vs.72.4%,P<0.05).IASBPD combined with UT or UTCC significantly improved the sensitivity(85.2%vs.78.5%,P>0.05),while attenuated the specificity(67.6%vs.76.8%,P<0.05)compared with IASBPD alone(all P<0.001).Conclusions:IASBPD combined with UT or UTCC is feasible and effective for screening subclavian stenosis,which could significantly improve the sensitivity for detecting SS as compared with IASBPD alone.
作者
邓宇
华倚虹
陈阳
董徽
马文韬
何际宁
邹玉宝
蒋雄京
DENG Yu;HUA Yihong;CHEN Yang;DONG Hui;MA Wentao;HE Jining;ZOU Yubao;JIANG Xiongjing(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2020年第6期588-593,共6页
Chinese Circulation Journal
基金
国家自然科学基金(81700440)。
关键词
锁骨下动脉狭窄
双臂间收缩压差
脉搏波上行时间
脉搏波上行时间占比
subclavian artery stenosis
inter-arm systolic blood pressure difference
upstroke time
upstroke time per cardiac cycle
