速度向量成像技术评价不同心血管危险分层的维持性血液透析患者颈动脉弹性的研究

Research of velocity vector imaging evaluating carotid arterial elasticity in maintenance hemodialysis patients with different cardiovascular risk stratification

摘要:

目的 探讨速度向量成像（VVI）技术对不同心血管危险分层的维持性血液透析（MHD）患者颈动脉弹性评价的临床价值。方法 选取2019年7月—2020年1月西南医科大学附属医院100例MHD患者，根据弗雷明汉风险评分将其分为低危组、中危组及高危组，同期选取该院40例健康志愿者作为对照组。常规超声测量各组颈动脉内-中膜厚度（IMT）、收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）、阻力指数等指标，VVI技术获取颈动脉收缩期峰值圆周应变（CS）、圆周应变率（CSR）及血管面积改变率（ΔS），用脉压差（PP）校正CS，即CS/PP。比较各组常规超声参数和VVI技术参数。Spearman法分析颈动脉常规超声参数与VVI技术参数的相关性和VVI技术参数与心血管危险分层的相关性。采用受试者工作特征（ROC）曲线分析VVI技术参数对高危型MHD患者的预测价值。结果 低危组、中危组、高危组及对照组的RI、PSV、EDV及IMT比较，差异有统计学意义（P <0.05）。低危组、中危组、高危组的CS、CSR、ΔS、CS/PP较对照组低（P <0.05），中危组和高危组的CS、CSR、ΔS、CS/PP较低危组低（P <0.05）；中危组和高危组的CS/PP比较，差异有统计学意义（P <0.05）。IMT与CS、CSR、ΔS、CS/PP呈负相关（r_s =-0.452、-0.397、-0.464和-0.540，均P =0.000）；PSV与CS、CSR、ΔS、CS/PP呈正相关（r_s ＝0.293、0.267、0.384和0.266，均P ＝0.000）；EDV与CS、CSR、ΔS、CS/PP呈正相关（r_s ＝0.334、0.342、0.390和0.426，均P ＝0.000）；RI与CS/PP呈负相关（r_s ＝-0.214，P ＝0.011），但RI与CS、CSR、ΔS无关（r_s ＝-0.086、-0.156和-0.117，P ＝0.311、0.065和0.170）。CS、CSR、ΔS、CS/PP与心血管危险分层呈负相关（r_s =-0.388、-0.529、-0.560和-0.397，均P <0.05）。ROC曲线结果显示，CS的ROC曲线下面积为0.826（95% CI：0.738，0.895），敏感性为78.6%（95% CI：0.683，0.868），特异性为81.3%（95% CI：0.544，0.960）；CSR的ROC曲线下面积为0.712（95%CI：0.613，0.798），敏感性为48.8%（95% CI：0.377，0.600），特异性为87.5%（95% CI：0.617，0.984）；ΔS的ROC曲线下面积为0.743（95% CI：0.645，0.825），敏感性为53.6%（95% CI：0.424，0.645），特异性为87.5%（95% CI：0.617，0.984）；CS/PP的ROC曲线下面积为0.888（95% CI：0.810，0.943），敏感性为81.0%（95% CI：0.709，0.887），特异性为87.5%（95% CI：0.617，0.984）。结论 VVI技术能较好地评价不同心血管危险分层的维持性血液透析患者颈动脉弹性变化，其参数与心血管危险分层相关，为临床干预提供新的影像学证据。

Abstract:

Objective To explore the clinical value of velocity vector imaging (VVI) in the evaluation of carotid artery elasticity in maintenance hemodialysis patients with different cardiovascular risk stratification.Methods One hundred patients with maintenance hemodialysis（MHD) were divided into low risk group, intermediate risk group, and high risk group, according to Framingham risk score, and another 40 healthy adults were selected as healthy control group. Carotid intima-media thickness (IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured by conventional ultrasound. The systolic peak circumferential strain (CS), circumferential strain rate (CSR), and vascular area change rate (ΔS) of common carotid artery were obtained by VVI technique. CS was adjusted for pulse pressure (CS/PP). Statistical analysis was performed on each parameter.Results CS, CSR, ΔS, and CS/PP in low risk group, intermediate risk group, and high risk group were significantly lower than those in control group, while CS, CSR, ΔS, and CS/PP in intermediate risk group and high risk group were lower than those in low risk group (P < 0.05). There was significant difference in CS/PP between intermediate risk group and high risk group (P < 0.05). IMT and CS, CSR, ΔS, CS / PP was negatively correlated (r_s = -0.452, -0.397, -0.464 and -0.540, all P = 0.000); PSV and CS, CSR, ΔS, CS / PP was positively correlated (r_s = 0.293, 0.267, 0.384 and 0.266, all P = 0.000); EDV and CS, CSR, ΔS, CS / PP was positively correlated (r_s = 0.334, 0.342, 0.390 and 0.426, all P = 0.000); RI was negatively correlated with CS / PP (r_s = -0.214, P = 0.011), but RI was not correlated with CS, CSR, ΔS (r_s = -0.086, - 0.156 and -0.117, P = 0.311, 0.065 and 0.170). CS, CSR, ΔS, CS/PP was negatively correlated with cardiovascular risk stratification (r_s = -0.388, -0.529, -0.560 and -0.397, all P < 0.05). The diagnostic value of CS, CSR, ΔS, and CS/PP was evaluated with ROC curve. The area under the ROC curve of CS was 0.826 (95% CI: 0.738, 0.895), the sensitivity was 78.6% (95% CI: 0.683, 0.868), and the specificity was 81.3% (95% CI: 0.544, 0.960); the area under the ROC curve of CSR was 0.712 (95% CI: 0.613, 0.798), the sensitivity was 48.8% (95% CI: 0.377, 0.600), and the specificity was 87.5% (95% CI: 0.617, 0.984); the area under the ROC curve of ΔS was 0.743 (95% CI: 0.645, 0.825), the sensitivity was 53.6% (95% CI: 0.424, 0.645), and the specificity was 87.5% (95% CI: 0.617, 0.984); the area under the ROC curve of CS/PP was 0.888 (95% CI: 0.810, 0.943), the sensitivity was 81.0% (95% CI: 0.709,0.887), and the specificity was 87.5% (95% CI: 0.617, 0.984).Conclusions Velocity vector imaging can assess changes of carotid artery elasticity in maintenance hemodialysis patients with different cardiovascular risk strata, of which parameters correlate with cardiovascular risk stratification, providing new imaging evidence for clinical intervention.