动脉硬化性肾动脉狭窄患者ARFI定量参数与血流动力学的关系及联合评价肾动脉狭窄程度的ROC曲线分析

doi:10.3969/j.issn.1007-3205.2025.01.016

河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (1): 92-98.doi: 10.3969/j.issn.1007-3205.2025.01.016

动脉硬化性肾动脉狭窄患者ARFI定量参数与血流动力学的关系及联合评价肾动脉狭窄程度的ROC曲线分析

1.河北医科大学第二医院鹿泉院区超声科,河北石家庄 050299;2.河北医科大学第二医院鹿泉院区影像科，河北石家庄 050299

出版日期:2025-01-25 发布日期:2025-01-22
作者简介:杨翠英（1984-），女，河北邯郸人，河北医科大学第二医院主治医师，医学硕士，从事腹部、浅表、血管及心脏超声诊断研究。
基金资助:
河北省医学科学研究课题计划（20200965）

The relationship between ARFI quantitative parameters and hemodynamics in patients with atherosclerotic renal artery stenosis and the ROC curve analysis of these indicators for jointly evaluating the severity of renal artery stenosis

1.Department of Ultrasound, Luquan Branch of the Second Hospital of Hebei Medical University,
Shijiazhuang 050299, China； 2.Department of Imaging, Luquan Branch of the Second
Hospital of Hebei Medical University, Shijiazhuang 050299, China

Online:2025-01-25 Published:2025-01-22

摘要/Abstract

摘要： 目的探讨动脉硬化性肾动脉狭窄（atherosclerotic renal arterial stenosis，ARAS）患者声辐射力脉冲弹性成像技术（acoustic radiation force impulse，ARFI）定量参数与血流动力学的关系，分析联合评价肾动脉狭窄程度的价值。
方法选取ARAS患者138例作为观察组，遵循1〖DK〗∶1原则选取同期健康体检者138例作为对照组。统计2组肾皮质、肾髓质、肾窦低频剪切波传导速度（shear wave velocity，SWV）、肾主动脉血流动力学指标［肾主动脉收缩期峰值流速（peak systolic velocity，PSV）、舒张末期流速（end diastolic velocity，EDV）、肾动脉与腹主动脉PSV比值（renal-aortic PSV ratio，RAR）、肾主动脉与叶间动脉PSV比值（renal-interlobar ratio，RIR）］，Pearson分析各指标间相关性，同时根据肾动脉狭窄程度分为轻中度、重度狭窄，比较不同肾动脉狭窄程度ARFI定量参数、血流动力学，采用受试者工作特征曲线（receiver operating characteristic curve，ROC）及曲线下面积（area under curve，AUC）、绝对净重新分类指数（net reclassification index，NRI）、综合判别改善指数（integrated discrimination improvement，IDI）评价肾动脉狭窄程度诊断效能。
结果 ①观察组肾主动脉EDV、PSV、RAR、RIR及肾皮质、肾髓质、肾窦SWV［（40.45±8.85） m/s、（151.12±35.35） m/s、（2.38±0.66）、（7.55±2.26）、（3.28±0.55） m/s、（2.40±0.46） m/s、（2.31±0.41） m/s］高于对照组［（25.62±4.41） m/s、（114.42±34.43） m/s、（1.70±0.48）、（5.24±1.58）、（2.66±0.43） m/s、（1.81±0.30） m/s、（1.88±0.33） m/s（P＜0.05）］。②ARAS患者肾皮质、肾髓质、肾窦SWV与EDV、PSV、RAR、RIR呈正相关（P＜0.05）。③重度肾动脉狭窄患者肾皮质、肾髓质、肾窦SWV及肾主动脉EDV、PSV、AT、RAR、RIR高于轻中度肾动脉狭窄患者（P＜0.05）；④肾皮质、肾髓质、肾窦SWV及EDV、PSV、RAR、RIR诊断肾动脉狭窄程度的AUC为0.813、0.827、0.752、0.809、0.802、0.758、0.819，且SWV结合血流动力学指标联合诊断NRI、IDI最大，分别为0.688（95%CI：0.450~0.971）、0.089（95%CI：0.030~0.115）。
结论 ARAS患者肾皮质、肾髓质、肾窦SWV呈高表达，且与血流动力学指标呈正相关，联合检测有利于提高肾动脉狭窄程度诊断效能，指导临床诊治。

关键词: 肾动脉梗阻, 弹性成像技术, 血流动力学

Abstract: Objective To investigate the relationship between quantitative parameters of acoustic radiation force impulse (ARFI) and hemodynamics in patients with atherosclerotic renal arterial stenosis (ARAS), and to analyze their value in combined evaluation of severity of renal artery stenosis.
Methods A total of 138 ARAS patients were selected as the observation group, and 138 healthy physical examinees were selected as the control group by 1〖DK〗∶1 principle. The shear wave velocity (SWV) of the renal cortex, renal medulla, and renal sinus, as well as the hemodynamic parameters of the renal aorta ［peak systolic velocity (PSV), end diastolic velocity (EDV), renal-aortic PSV ratio (RAR), renal-interlobar ratio (RIR)］ were recorded in two groups. Pearson analysis was used to assess the correlation between these parameters. Based on the degree of renal artery stenosis, patients were categorized into mild to moderate, and severe stenosis groups. The quantitative parameters of ARFI and hemodynamic parameters were compared among patients with different degrees of renal artery stenosis. The receiver operating characteristic (ROC) curve, area under ROC curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the diagnostic efficiency of renal artery stenosis.
Results ①EDV, PSV, RAR, RIR, and SWV of the renal aorta, renal cortex, renal medulla, and renal sinus in the observation group ［(40.45±8.85) m/s, (151.12±35.35) m/s, (2.38±0.66), (7.55±2.26), (3.28±0.55) m/s, (2.40±0.46) m/s, (2.31±0.41) m/s, respectively］ were higher than those in the control group ［(25.62±4.41) m/s, (114.42±34.43) m/s, (1.70±0.48), (5.24±1.58), (2.66±0.43) m/s, (1.81±0.30) m/s, (1.88±0.33) m/s (P＜0.05), respectively］. ②In ARAS patients, the SWV of the renal cortex, renal medulla, and renal sinus was positively correlated with EDV, PSV, RAR, and RIR (P＜0.05). ③The SWV of renal cortex, renal medulla, renal sinus, and the EDV, PSV, AT, RAR, and RIR of renal aorta in patients with severe renal artery stenosis were higher than those in patients with mild to moderate renal artery stenosis (P＜0.05). ④The AUC of SWV in the renal cortex, renal medulla, and renal sinus, EDV, PSV, RAR, and RIR for diagnosing the degree of renal artery stenosis was 0.813, 0.827, 0.752, 0.809, 0.802, 0.758, and 0.819, respectively. The combination of SWV and hemodynamic parameters had the highest diagnostic accuracy for NRI and IDI, with AUC of 0.688 (95%CI: 0.450-0.971) and 0.089 (95%CI: 0.030-0.115), respectively.
Conclusion The SWV in the renal cortex, renal medulla, and renal sinus of ARAS patients shows high expression and is positively correlated with hemodynamic parameters. Combined detection is beneficial to improving the diagnostic efficiency of renal artery stenosis and guiding clinical diagnosis and treatment.

Key words: renal artery obstruction, elastic imaging technology, hemodynamics

杨翠英1, 薛丽丽1, 赵雅培1, 赵艳琴1, 张冬青2, 谢迎新1. 动脉硬化性肾动脉狭窄患者ARFI定量参数与血流动力学的关系及联合评价肾动脉狭窄程度的ROC曲线分析 [J]. 河北医科大学学报, 2025, 46(1): 92-98.

YANG Cui-ying1, XUE Li-li1, ZHAO Ya-pei1, ZHAO Yan-qin1, ZHANG Dong-qing2, XIE Ying-xin1. The relationship between ARFI quantitative parameters and hemodynamics in patients with atherosclerotic renal artery stenosis and the ROC curve analysis of these indicators for jointly evaluating the severity of renal artery stenosis [J]. Journal of Hebei Medical University, 2025, 46(1): 92-98.

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动脉硬化性肾动脉狭窄患者ARFI定量参数与血流动力学的关系及联合评价肾动脉狭窄程度的ROC曲线分析

The relationship between ARFI quantitative parameters and hemodynamics in patients with atherosclerotic renal artery stenosis and the ROC curve analysis of these indicators for jointly evaluating the severity of renal artery stenosis

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