Objective To study the accuracy of improved systolic/diastolic ratio (S/D ratio) in judging the prognosis in renal allograft with reversed diastolic flow (RDF). Methods According to the transplant nephrectomy or not,patients with RDF in renal allograft were classified into two groups: surgical group (n=5) and nonsurgical group (n=19 ). Difference of improved S/D ratio between the two groups were analysed. Improved S/D ratio was defined as a ratio of peak systolic velocity divided by peak diastolic velocity. Receiver operating characteristic (ROC) curve was constructed for improved S/D ratio to evaluate diagnostic accuracy in judging the prognosis in renal allograft with RDF. Results Improved S/D ratio in surgical group was lower than nonsurgical group (t=2. 172, P=0. 041 ). Areas under ROC curve for improved S/D ratio was 0. 974. An improved S/D ratio threshold was 2. 7 with 100％ sensitivity,80％ specificity, 95％ positive predictive value, and 100％ negative predictive value for renal aliograft with RDF loss. With this cutoff value to predict renal allograft with RDF loss or not and to predict the function of renal allograft with RDF recovered or not, the accuracy were 96％ and 87％ respectively. Conclusions Improved S/D ratio can not only serve as a useful noninvasive index to predict renal allograft with RDF loss or not , but also serve as a useful noninvasive index to predict the function of renal allograft with RDF recovered or not.%目的 探讨改良S/D比值在移植肾出现舒张期反向血流(RDF)时评价移植肾预后的准确性.方法 24例移植肾RDF患者按照其保肾是否成功分为手术组(5例)和非手术组(19例),对其改良S/D比值进行分析比较,改良S/D比值的定义为收缩期峰值流速与舒张期峰值流速之比.并用ROC曲线评价改良S/D比值判断移植肾预后的准确性.结果 移植肾RDF时手术组改良S/D比值低于非手术组(t=2.172,P=0.041).ROC曲线评价改良S/D比值判断移植肾预后的ROC曲线下面积为0.974,改良S/D比值评估移植肾预后的最佳界值为2.7,其在移植肾RDF时评价移植肾保肾是否成功的敏感性为100%,特异性为80%,阳性预测值为95%,阴性预测值为100%,准确性为96%;其评估RDF治疗后移植肾功能是否恢复正常的准确性为87%.结论 改良S/D比值在移植肾出现RDF时对评估移植肾预后是一个无创有价值的指标.
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