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目的 探讨运用受试者工作特征(ROC)曲线分析彩色多普勒超声检查对老年人动脉粥样硬化性肾动脉狭窄(ARAS)程度的评估价值.方法 选择2015年3月至2018年9月浙江大学医学院附属第一医院安吉分院收治的ARAS患者117例为研究对象,患者均行彩色多普勒超声检查以及肾动脉造影检查确诊,以肾动脉造影作为金标准,分析彩色多普勒超声对ARAS诊断价值,比较不同狭窄程度肾动脉彩色多普勒超声指标变化,并采取ROC曲线分析彩色多普勒超声对老年人ARAS的评估价值.结果 以肾动脉造影作为金标准,彩色多普勒超声检查ARAS敏感性为82.17％(129/157),诊断特异性为80.52％(62/77).重度狭窄组收缩期峰值血流速度(PSV)[(227.59±34.28) cm/s]和舒张末期流速(EDV)[(57.39±6.48) cm/s]高于中度狭窄组[(183.84±41.05) cm/s和(50.29±5.22)cm/s](t=6.269、6.506,均P＜0.05)、轻度狭窄组[(128.47±52.35) cm/s和(37.52±7.15) cm/s](t=10.517、12.813,均P＜0.05)、无狭窄组[(86.49±28.94)cm/s和(26.48±5.02)cm/s](t=18.598、21.971,均P＜0.05);重度狭窄组阻力指数(RI)[(0.41±0.07)]低于中度狭窄组[(0.47±0.06)](t=4.966,P＜0.05)、轻度狭窄组[(0.52±0.07)](t=8.496,P＜0.05)、无狭窄组[(0.70±0.11)](t=17.101,P＜0.05).采用ROC曲线分析彩色多普勒超声各参数对中重度狭窄诊断价值,PSV、EDV、RI对中重度狭窄诊断曲线下面积分别为0.869、0.932、0.937.结论 彩色多普勒超声对老年ARAS患者早期诊断以及临床筛查具有着重要意义,有助于对患者肾动脉狭窄程度的判断以及病情的评估,且检查无创、简便、廉价,值得临床推广运用.“,”Objective To evaluate the clinical value of color Doppler ultrasonography (CDFI) in evaluating the degree of atherosclerotic renal artery stenosis (ARAS) in the elderly by using ROC curve analysis.Methods From March 2015 to September 2018,117 patients with ARAS admitted to Anji Branch of the First Affiliated Hospital of Medical College of Zhejiang University were selected.All patients underwent color Doppler ultrasonography and renal artery angiography.Renal artery angiography was used as the gold standard.The diagnostic value of color Doppler ultrasonography for ARAS was analyzed.The changes of color Doppler ultrasonography indicators of renal artery in different degrees of stenosis were compared.The ROC curve was used to analyze the value of color Doppler ultrasound in evaluating the degree of atherosclerotic renal artery stenosis in the elderly.Results Using renal arteriography as the gold standard,the sensitivity of color ultrasonography for ARAS was 82.17％ (129/157),and the specificity of diagnosis was 80.52％ (62/77).The PSV [(227.59 ± 34.28) cm/s] and EDV [(57.39 ± 6.48) cm/s] in the severe stenosis group were higher than those in the moderate stenosis group [(183.84 ±41.05) cm/s and(50.29 ± 5.22) cm/s] (t =6.269,6.506,all P ＜ 0.05) and the mild stenosis group [(128.47 ± 52.35) cm/s and(37.52 ± 7.15) cm/s] (t =10.517,12.813,all P ＜ 0.05) and the non-stenosis group [(86.49 ± 28.94) cm/s and (26.48 ± 5.02) cm/s] (t =18.598,21.971,all P ＜ 0.05).The RI in the severe stenosis group [(0.41 ±0.07)] was lower than that in the moderate stenosis group [(0.47 ± 0.06)] (t =4.966,P ＜ 0.05) and the mild stenosis group [(0.52 ±0.07)] (t =8.496,P ＜0.05) and the no stenosis group [(0.70 ±0.11)] (t =17.101,P ＜ 0.05).The ROC curve was used to analyze the diagnostic value of color ultrasound parameters for moderate and severe stenosis.The area under the diagnostic curve of PSV,EDV and RI for moderate and severe stenosis was 0.869,0.932 and 0.937,respectively.Conclusion CDFI plays an important role in the early diagnosis and clinical screening of elderly patients with ARAS.It is helpful to judge the degree of renal artery stenosis and evaluate the condition of the patients.It is non-invasive,simple and inexpensive,and worthy of clinical application.