急性下肢深静脉血栓形成患者行CDT联合ART治疗前后监测超声弹性成像参数变化对疗效的评估价值

doi:10.3969/j.issn.1006-5725.2023.18.013

摘要/Abstract

摘要：

目的分析急性下肢深静脉血栓形成（DVT）患者行导管接触性溶栓（CDT）联合AngioJet机械性血栓抽吸术（ART）治疗前后监测超声弹性成像参数变化对疗效的评估价值。方法选择2021年8月至2022年8月衡水人民医院收治的100例DVT患者，所有患者均接受CDT联合ART治疗，术后接受药物治疗，共治疗10 d。观察患者治疗前、治疗10 d后患肢肿胀情况、超声弹性成像参数。根据疗效不同将患者分为无效组和有效组，比较两组基线资料及治疗前超声弹性成像参数；绘制受试者工作曲线（ROC），检验超声弹性成像参数对DVT患者治疗无效的预测价值；采用双相关变量Spearman分析超声弹性成像参数与DVT患者治疗无效相关性。结果 100例DVT患者经CDT联合ART治疗后，显效34例（34.00%），有效53例（53.00%），无效13例（13.00%）；DVT患者治疗后的患健侧大腿周径差、患健侧小腿周径差相比治疗前小，超声弹性成像评分、应变值、杨氏模量值相比治疗前低（P < 0.05）；无效组治疗前超声弹性成像评分、应变值、杨氏模量值相比有效组高（P < 0.05）；绘制ROC曲线结果显示，超声弹性成像评分、应变值、杨氏模量值水平及联合检测预测DVT患者临床疗效有一定预测价值（AUC = 0.803、0.793、0.771），其中联合检测最高（AUC = 0.946）；采用双相关变量Spearman分析，结果显示，超声弹性成像评分、应变值、杨氏模量值与DVT患者治疗无效呈正相关（r > 0，P < 0.05）。结论超声弹性成像参数能够有效预测DVT患者CDT联合ART治疗后临床疗效，超声弹性成像参数变化与治疗无效呈正相关。

关键词: 急性下肢深静脉血栓, 导管接触性溶栓, AngioJet机械性血栓抽吸术, 超声弹性成像参数, 临床疗效

Abstract:

Objective To analyze the value of monitoring changes in ultrasound elastography parameters before and after treatment with catheter contact thrombolysis （CDT） combined with AngioJet mechanical thrombus aspiration （ART） in patients with acute lower extremity deep vein thrombosis （DVT） for the assessment of efficacy. Methods One hundred patients with DVT admitted to Hengshui people′s hospital from August 2021 to August 2022 were selected， and all patients received CDT combined with ART and postoperative medication for 10 d. Patients were observed for swelling of the affected limb before and after 10 d of treatment， ultrasound elastography parameters. Patients were divided into ineffective group and effective group according to different curative effects， and baseline data and ultrasonic elastography parameters before treatment were compared between the two groups； the subject operating curve （ROC） was plotted， and the area under the curve （AUC） values were calculated to test the predictive value of ultrasound elastography parameters for treatment ineffectiveness in DVT patients； Spearman's analysis of ultrasound elastography parameters and treatment ineffectiveness in DVT patients was performed using a bivariate correlation variable The correlation between ultrasound elastography parameters and treatment ineffectiveness in DVT patients was analyzed using the bicorrelation variable Spearman. Results After 100 patients with DVT were treated with CDT combined with ART， 34（34.00%） were effective， 53（53.00%） were effective， and 13（13.00%） were ineffective； After treatment， the circumference difference of the affected side thigh and the circumference difference of the affected side calf of DVT patients were smaller than before treatment， and the ultrasonic elastography score， strain value and Young's modulus value were lower than before treatment （P < 0.05）. The ultrasonic elastography score， strain value and Young's modulus in the ineffective group were higher than those in the effective group before treatment （P < 0.05）. The ROC curve shows that the ultrasonic elastography score， strain value， Young's modulus level and combined detection have certain predictive value in predicting the clinical efficacy of DVT patients （AUC = 0.803， 0.793， 0.771）， and the combined detection is the highest （AUC = 0.946）. Among them， the combined test was the highest； using Spearman analysis of dual correlation variables， the results showed that ultrasound elastography score， strain value， and Young's modulus value were positively correlated with treatment ineffectiveness in patients with DVT （r > 0， P<0.05）. Conclusion Ultrasound elastography parameters can effectively predict clinical outcomes after CDT combined with ART in DVT patients， and changes in ultrasound elastography parameters were positively correlated with treatment ineffectiveness.

Key words: acute lower extremity deep vein thrombosis, catheter-contact thrombolysis, angioJet mechanical thrombus aspiration, ultrasound elastography parameters, clinical efficacy

中图分类号:

R543.6

潘江皓,孙健铭,宋家明,付广印,雷勇,张晓洁. 急性下肢深静脉血栓形成患者行CDT联合ART治疗前后监测超声弹性成像参数变化对疗效的评估价值[J]. 实用医学杂志, 2023, 39(18): 2362-2367.

Jianghao PAN,Jianming SUN,Jiaming SONG,Guangyin FU,Yong LEI,Xiaojie. ZHANG. Evaluation value of monitoring changes of ultrasonic elastic imaging parameters before and after CDT combined with ART in patients with acute deep venous thrombosis of lower extremities[J]. The Journal of Practical Medicine, 2023, 39(18): 2362-2367.

图/表 6

表1

表2

表3

两组基线资料及超声弹性成像参数比较 (例（%）)"

资料	无效组（n = 13）	有效组（n = 87）	χ²/t值	P值
性别			0.940	0.332
男	8（61.54）	41（47.13）
女	5（38.46）	46（52.87）
年龄			0.321	0.571
≥ 60岁	6（46.15）	33（37.93）
< 60岁	7（53.85）	54（62.07）
体质量指数			0.531	0.466
≥ 24 kg/m²	9（69.23）	51（58.62）
< 24 kg/m²	4（30.77）	36（41.38）
患侧			0.281	0.596
左下肢	7（53.85）	40（45.98）
右下肢	6（46.15）	47（54.02）
病理类型			0.053	0.818
中心型血栓	3（23.08）	14（16.09）
混合型血栓	10（76.92）	73（83.91）
患健侧大腿周径差（ $x ˉ$ ±s，cm）	8.14 ± 1.86	8.40 ± 1.44	0.584	0.561
患健侧小腿周径差（ $x ˉ$ ±s，cm）	2.87 ± 1.09	2.21 ± 1.21	1.856	0.066
静脉通畅评分（ $x ˉ$ ±s，分）	8.09 ± 1.35	7.57 ± 1.17	1.465	0.146
超声弹性成像评分（ $x ˉ$ ±s，分）	3.48 ± 0.68	2.91 ± 0.41	4.243	< 0.001
应变值（ $x ˉ$ ±s，cm）	1.64 ± 0.26	1.38 ± 0.19	4.374	< 0.001

表3

图1

表4

表5

参考文献 22

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时间	患健侧大腿周径差	患健侧小腿周径差
治疗前（n = 100）	8.32 ± 1.49	2.38 ± 1.18
治疗后（n = 100）	2.75 ± 1.06	1.54 ± 0.73
t值	29.969	6.054
P值	< 0.001	< 0.001

时间	超声弹性成像评分/分	应变值	杨氏模量值/kPa
治疗前（n = 100）	3.02 ± 0.46	1.47 ± 0.21	23.15 ± 4.06
治疗后（n = 100）	1.24 ± 0.19	0.59 ± 0.11	11.18 ± 2.43
t值	35.765	37.121	25.298
P值	< 0.001	< 0.001	< 0.001

因素	AUC	cut-off值	95%CI	P值	特异度	灵敏度	约登指数
超声弹性成像评分	0.803	3.335分	0.618 ~ 0.987	< 0.001	0.862	0.769	0.631
应变值	0.793	1.425	0.652 ~ 0.933	0.001	0.609	0.846	0.455
杨氏模量值	0.771	26.345 kPa	0.612 ~ 0.929	0.002	0.851	0.769	0.620
联合检测	0.946		0.879 ~ 1.000	< 0.001	0.908	0.923	0.831

指标	临床疗效	超声弹性成像评分	应变值	杨氏模量值
临床疗效	-	r = 0.398，P < 0.001	r = 0.341，P = 0.000	r = 0.330，P = 0.001
超声弹性成像评分	r = 0.398，P = 0.000	-	r = 0.148，P = 0.143	r = 0.039，P = 0.701
应变值	r = 0.411，P = 0.000	r = 0.148，P = 0.143	-	r = 0.088，P = 0.384
杨氏模量值	r = 0.330，P = 0.001	r = 0.039，P = 0.701	r = 0.088，P = 0.384	-

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