Study On Atypical Ultrasound Doppler Spectrum Of Lower Extremity Arteries With Normal Lumen Structure

Objective: To explore the significance of atypical spectrum of lower extremity arteries with normal lumen structure.That is to say,?To explore the atypical spectrum waveform types of lower extremity arteries with normal lumen structure in healthy people and the influencing factors;?To clarify the difference of systolic indexes between atypical spectrum of lower extremity arteries with normal lumen structure in healthy people and narrowed distal spectrum;?To determine the correlation between the occurrence of atypical spectrum and lumbar nerve root compression.And to study the difference of systolic indexes between the spectrum of lower extremity arteries with normal lumen structure in lumbar spinal stenosis(LSS)patients and narrowed distal spectrum.Methods: The ultrasonic Doppler spectrum waveforms of lower extremity arteries,spectral systolic parameters of lower extremity arteries and general clinical features of healthy people were collected from 225 patients in the Ultrasound Department of the first Hospital of Jilin University.the 225 patients included 200 patients with normal lower extremity arteries(including 150 healthy people and 50 LSS patients)and 25 patients with pure localized stenosis of lower extremity arteries.?Classify spectrum patterns,and to summarize the types of atypical spectrum waveforms of lower extremity arteries with normal lumen structure in healthy people and analyze the key factors that affecting the occurrence of atypical waveforms:The latter determines the optimal critical value(the maximum of the Jordan index)according to the receiver operating characteristic curve(ROC curve).The Logistic regression is used to analyze the single factor and the multi-factor,in which the ratio and 95% confidence interval are used to express the compactness of the relation.?Locating the lower extremity artery with normal lumen structure,which is the most prone to atypical spectrum,and the systolic spectrum indexes between the artery with normal lumen structure in healthy people and the same artery in patients with simple stenosis of lower extremity artery was compared: According to the change of systolic indexes of spectrum,The optimal threshold of each index was determined by using the ROC curve(at the maximum of the Jordan index),and the difference between the atypical spectrum and the narrow distal spectrum was compared by chi-square test.The significant indexes were included in the multi-factor analysis of Logistic regression.The independent factors were graded according to the ? value(absolute value)of multifactor analysis,and the joint diagnosis model was established.The diagnostic value of the joint diagnosis model was evaluated by ROC curve.?Study on the correlation between atypical spectrum of lower extremity arteries with normal lumen structure and lumbar nerve root compression: the differences between the two groups were compared by Chi-square test.Locating the lower extremity artery with normal lumen structure,which is the most prone to atypical spectrum,Based on ischemic symptoms,the systolic spectrum indexes between the artery with normal lumen structure in LSS patients and the same artery in patients with simple stenosis of lower extremity artery was compared: According to the change of systolic indexes of spectrum,The optimal threshold of each index was determined by using ROC curve(at the maximum of the Jordan index),and the difference between the atypical spectrum and the narrow distal spectrum was compared by chi-square test.The significant indexes were included in the multifactor analysis of Logistic regression.The independent factors were graded according to the ? value(absolute value)of multi-factor analysis,and the joint diagnosis model was established.The diagnostic value of the joint diagnosis model was evaluated by ROC curve.All the results were analyzed by double tail method,the difference was statistically significant,and the data were processed by IBM SPSS 23 software.Result:(1)The atypical spectrum waveforms of lower extremity arteries with normal lumen structure were diverse in healthy people,and mainly focused on diastolic waveform changes,especially in distal limb arteries.Univariate analysis showed that:sex,age,height,weight,heart rate,systolic blood pressure,diastolic blood pressure and body mass index(BMI)were associated with atypical spectrum of lower extremity arteries.Multi-variate analysis: height(RO=0.300,95% CI:0.145-0.618,P<0.05)and diastolic pressure(RO=0.289,95% CI:0.128-0.656,P< 0.05)were independent influencing factors.(2)Taking the anterior tibia artery(ATA)with normal lumen structure as an example,Analysis of systolic indexes of ATA atypical spectrum and distal stenosis spectrum: peak systolic velocity(PSV),acceleration time(AT),The systolic duration(ST)and deceleration time(DT)?PSV/AT?PSV/DT were significantly different(chi-square values were 34.615,20.032,11.880,6.797,36.057 and 41.606,respectively,P< 0.05);Multi-variate analysis: PSV,ST were independent indexes of difference;The sensitivity and specificity of the combined diagnostic model were 68.8% and 100%,respectively,The area under ROC curve was 0.910(95% CI 0.835-0.985).(3)The superficial femoral artery(SFA),popliteal artery(POA)and posterior tibial artery(PTA)with normal lumen structure in LSS patients were more likely to have atypical spectral changes than those in healthy people,and the difference was statistically significant(P<0.05).Taking the PTA with normal lumen structure as an example,Analysis of systolic parameters of PTA spectrum and distal stenosis spectrum,Single factor analysis: PSV?ST?AT?AT/ST?acceleration(AC)?DT?DT/ST?deceleration(DC)?PSV/AT?PSV/DT were significantly different(chi-square values were31.429,55.600,44.508,4.398,38.189,26.193,5.164,39.182,47.232,40.356,respectively,P<0.05);Multi-variate analysis: ST?DT/ST?PSV/AT were independent indexes of difference;The sensitivity and specificity of the combined diagnostic model were 82.9% and 91.9%,respectively,The area under ROC curve was 0.94(95% CI 0.893-0.988).Conclusion:(1)The atypical spectrum diastolic waveforms of lower extremity arteries with normal lumen structure were diverse in healthy people,and the changes of ATA and PTA were the main changes.Height and diastolic pressure were independent factors.(2)When the ATA appeared atypical spectrum and measured PSV?76cm/s and PSV/DT?0.32cm/s/ms,it was more likely that there was no stenosis in the upper segment of the patient.(3)The occurrence of atypical spectral patterns of lower extremity arteries with normal lumen structure may be related to lumbar nerve root compression.When pain,numbness,cooling,claudication and other similar symptoms occur in the lower extremities of the patient,the spectrum of the PTA of the patient is measured: ST < 293 ms and / or(DT/ST ?0.62 and PSV/AT?0.43),it was more likely that there was no stenosis in the upper segment of the patient.