Van der Velden S K, De Maeseneer M G R, Pichot O, Nijsten T, van den Bos R R
Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.
Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2016 Jun;51(6):831-7. doi: 10.1016/j.ejvs.2016.02.019. Epub 2016 Apr 16.
The aim of this study was to analyze the correlation between the extent of diameter change from standing to supine position ("postural diameter change," PDC), and patient or duplex ultrasound (DUS) characteristics in lower limbs with and without saphenous trunk (ST) reflux.
Measurements were carried out in 193 limbs with primary great saphenous vein, anterior accessory saphenous vein, or small saphenous vein reflux, and 48 control limbs without ST reflux. The inner diameter of the ST was measured with DUS in the standing and lying positions. The PDC, calculated as a percentage, followed the formula: (standing diameter - lying diameter)/standing diameter × 100. Clinical findings (according to the highest "C" - of the CEAP classification), venous clinical severity score, body mass index (BMI), time of visit, and inside and outside temperature were documented. Limbs were divided into two groups using the median value of PDC as a cut off to increase interpretability of the analysis.
The median PDC of the ST was 19% in limbs with ST reflux compared with 24% in control limbs (p = .16). In limbs with and without ST reflux, only older age and increased BMI were independently associated with a low PDC of the ST (R(2) 0.13). In limbs with ST reflux, median PDC was significantly lower in C4-C6 (16%, interquartile [IQR] 8-21) than in C0-C1 (23%, IQR 12-35) or C2-C3 limbs (21%, IQR 11-33; p = .016). In addition, PDC was significantly lower in veins with a large diameter (>7 mm) than in those with a small diameter (p = .003).
Low PDC of the ST correlates with older age and increased BMI. Whether PDC might become a useful additional DUS tool to classify the severity of chronic venous disease and thereby influence the management strategy should be further investigated.
本研究旨在分析从站立位到仰卧位时直径变化程度（“体位性直径变化”，PDC）与有或无大隐静脉主干（ST）反流的下肢患者或双功超声（DUS）特征之间的相关性。
对193条存在原发性大隐静脉、前副大隐静脉或小隐静脉反流的肢体以及48条无ST反流的对照肢体进行测量。采用DUS在站立位和卧位测量ST的内径。PDC以百分比计算，公式为：（站立位直径 - 卧位直径）/站立位直径× 100。记录临床发现（根据CEAP分类中最高的“C”级）、静脉临床严重程度评分、体重指数（BMI）、就诊时间以及室内外温度。以PDC的中位数作为分界值将肢体分为两组，以提高分析的可解释性。
有ST反流的肢体中ST的PDC中位数为19%，而对照肢体中为24%（p = 0.16）。在有和无ST反流的肢体中，仅年龄较大和BMI增加与ST的低PDC独立相关（R² 0.13）。在有ST反流的肢体中，C4 - C6级（16%，四分位间距[IQR] 8 - 21）的PDC中位数显著低于C0 - C1级（23%，IQR 12 - 35）或C2 - C3级肢体（21%，IQR 11 - 33；p = 0.016）。此外，直径较大（>7 mm）的静脉中的PDC显著低于直径较小的静脉（p = 0.003）。
ST的低PDC与年龄较大和BMI增加相关。PDC是否可能成为一种有用的额外DUS工具来对慢性静脉疾病的严重程度进行分类，从而影响治疗策略，有待进一步研究。
