Bays R A, Healy D A, Atnip R G, Neumyer M, Thiele B L
Section of Vascular Surgery, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.
J Vasc Surg. 1994 Nov;20(5):721-7. doi: 10.1016/s0741-5214(94)70159-8.
The purpose of this study was to validate the diagnostic capabilities of the most commonly used noninvasive modalities for evaluation of chronic venous insufficiency.
Twenty limbs in 20 patients were studied with air plethysmography (APG), photoplethysmography (PPG), and duplex ultrasonography. Ten limbs (group 1) were clinically without any venous disease. Group 2 consisted of 10 limbs with severe, class 3 venous stasis. Duplex ultrasonography, complemented with Doppler color-flow imaging was used to examine the superficial and deep venous systems to identify reflux.
Ultrasonography identified deep venous reflux in eight of 10 limbs in group 2. Severe superficial reflux was identified in the two remaining limbs. Seven limbs with deep reflux also demonstrated severe superficial reflux. Superficial venous reflux was identified in one leg in group 1. APG accurately separated normal limbs from those with reflux. Parameters that were significantly different (p < 0.05) between the two groups were the venous filling index, (group 1 = 1.37 +/- 1.16 ml/sec, group 2 = 29.5 +/- 6.2 ml/sec.), venous volume (group 1 = 107 +/- 10.1 ml, group 2 = 220 +/- 22.5 ml), ejection fraction (group 1 = 52.5% +/- 2.3%, group 2 = 32.5% +2- 4.6%), and residual volume fraction (group 1 = 21.4 +/- 2.0%, group 2 = 52.1% +/- 2.5%). PPG refill times were significantly shortened in group 2 versus those of group 1 (6.4 +/- 0.89 sec vs 20.2 +/- 1.1 sec). The sensitivity of PPG refill times to identify reflux was 100%, but the specificity was only 60%, whereas the sensitivity and specificity for the residual volume fraction was 100%. The venous filling index was able to identify reflux and determine whether only superficial reflux was present with a sensitivity of 100% and a specificity of 90%. The kappa coefficient of agreement between duplex scanning and APG was 0.83, whereas between duplex and PPG it was only 0.47.
APG accurately identifies limbs with and without venous reflux when compared with duplex ultrasonography. APG is a better method of evaluating clinically significant venous reflux than PPG. PPG is a sensitive method of detecting reflux, but the specificity is poor, and PPG refill times cannot accurately predict the location of reflux. The combination of APG and duplex ultrasonography provides the best means of assessing venous reflux.
本研究旨在验证最常用的非侵入性检查方法对慢性静脉功能不全的诊断能力。
对20例患者的20条肢体进行了空气容积描记法（APG）、光电容积描记法（PPG）和双功超声检查。10条肢体（第1组）临床无任何静脉疾病。第2组由10条患有严重3级静脉淤滞的肢体组成。采用双功超声检查并辅以彩色多普勒血流成像来检查浅静脉和深静脉系统以确定反流情况。
超声检查在第2组的10条肢体中的8条发现了深静脉反流。在其余2条肢体中发现了严重的浅静脉反流。7条有深静脉反流的肢体也显示有严重的浅静脉反流。在第1组的1条腿中发现了浅静脉反流。APG能准确区分正常肢体和有反流的肢体。两组之间有显著差异（p<0.05）的参数有静脉充盈指数（第1组=1.37±1.16 ml/秒，第2组=29.5±6.2 ml/秒）、静脉容量（第1组=107±10.1 ml，第2组=220±22.5 ml）、射血分数（第1组=52.5%±2.3%，第2组=32.5%±4.6%）和残余容积分数（第1组=21.4±2.0%，第2组=52.1%±2.5%）。与第1组相比，第2组的PPG再充盈时间显著缩短（6.4±0.89秒对20.2±1.1秒）。PPG再充盈时间识别反流的敏感性为100%，但特异性仅为60%，而残余容积分数的敏感性和特异性均为100%。静脉充盈指数能够识别反流并确定是否仅存在浅静脉反流，敏感性为100%，特异性为90%。双功扫描与APG之间的一致性kappa系数为0.83，而双功扫描与PPG之间仅为0.47。
与双功超声检查相比，APG能准确识别有无静脉反流的肢体。与PPG相比，APG是评估具有临床意义的静脉反流的更好方法。PPG是检测反流的敏感方法，但特异性较差，且PPG再充盈时间不能准确预测反流的部位。APG与双功超声检查相结合提供了评估静脉反流的最佳手段。
