Iafrati M D, Welch H, O'Donnell T F, Belkin M, Umphrey S, McLaughlin R
Department of Vascular Surgery, New England Medical Center, Boston, MA 02111.
J Vasc Surg. 1994 Jun;19(6):1001-7. doi: 10.1016/s0741-5214(94)70211-x.
Noninvasive tests for the evaluation of chronic venous insufficiency (CVI) include quantitative photoplethysmography (QPG), air plethysmography, and duplex ultrasonography measurement of valve closure time (VCT). These tests have been shown to accurately identify the presence of CVI, define the disease, and locate the involved segments. However, the correlation of noninvasive assessment of CVI with the clinical severity (Society for Vascular Surgery/International Society for Cardiovascular Surgery staging) has not been addressed critically.
During an 18-month period, 74 limbs were prospectively evaluated with clinical examination, air plethysmography, QPG and duplex ultrasonography.
We studied 52 patients with a mean age of 46 years. There were 14 stage 0 limbs, 14 stage 1, 15 stage 2, and 31 stage 3. We found significant differences (p < 0.05) between normal limbs and those with CVI only by VCT and QPG. There were also marked trends toward worsening mean values for reflux (VCT, QPG, and venous filling index) and venous hypertension (residual volume fraction) between stages 0 to 1, and 1 to 2; however, there was a large degree of overlap between all groups. No test discriminated stage 2 from 3. Assessment of calf muscle pump function with ejection fraction showed no difference between any groups.
The Society for Vascular Surgery/International Society for Cardiovascular Surgery criteria for CVI staging distinguishes ulcerated limbs (stage 3) from those with nonulcerating skin changes (hyperpigmentation, brawny edema, and subcutaneous fibrosis) (stage 2). However, we were not able to distinguish these groups by available noninvasive methods. This may imply that these tests are not accurate enough or that the progression from lipodermatosclerosis to frank ulceration is not accounted for by large-vessel hemodynamic changes, but rather by microcirculatory alterations.
用于评估慢性静脉功能不全（CVI）的非侵入性检查包括定量光电容积描记法（QPG）、空气容积描记法以及瓣膜关闭时间（VCT）的双功超声测量。这些检查已被证明能够准确识别CVI的存在、明确疾病情况并定位受累节段。然而，CVI的非侵入性评估与临床严重程度（血管外科学会/国际心血管外科学会分期）之间的相关性尚未得到严格探讨。
在18个月期间，对74条肢体进行了临床检查、空气容积描记法、QPG和双功超声的前瞻性评估。
我们研究了52例平均年龄为46岁的患者。有14条0期肢体、14条1期、15条2期和31条3期肢体。我们发现正常肢体与仅通过VCT和QPG诊断为CVI的肢体之间存在显著差异（p < 0.05）。在0至1期以及1至2期之间，反流（VCT、QPG和静脉充盈指数）和静脉高压（残余容积分数）的平均值也有明显的恶化趋势；然而，所有组之间存在很大程度的重叠。没有一项检查能够区分2期和3期。用射血分数评估小腿肌肉泵功能，各分组之间没有差异。
血管外科学会/国际心血管外科学会的CVI分期标准将溃疡肢体（3期）与有非溃疡皮肤改变（色素沉着、硬性水肿和皮下纤维化）的肢体（2期）区分开来。然而，我们无法通过现有的非侵入性方法区分这些组。这可能意味着这些检查不够准确，或者从脂性硬皮病发展到明显溃疡并非由大血管血流动力学变化引起，而是由微循环改变所致。
