目的 探讨彩色多普勒超声评估肱动脉血流参数对自体动静脉内瘘(arterio-venous fistula，AVF)并发头静脉吻合口狭窄的诊断价值。 方法  将行AVF的96例维持性血液透析患者(maintenance hemodialysis，MHD)超声检查和AVF功能分为头静脉吻合口狭窄组(n=37)和无狭窄组(n=59)，采用彩色多普勒超声测量肱动脉的平均时间流速(time-averaged mean velocity，TAMV)、搏动参数(pulsatility index，PI)、阻力参数(resistance index，RI)、收缩期峰值流速(peak systolic velocity，PSV)、舒张期末峰流速(end-diastolic velocity，EDV)等血流参数，并比较2组数据的差异性，采用受试者工作特征曲线(receiver operating characteristics，ROC)评价肱动脉血流参数对AVF并发头静脉吻合口狭窄的诊断价值。 结果  2组肱动脉内径和RI比较无统计学差别(t=1.674、0.514，P=0.097、0.609)。狭窄组肱动脉血流量、TAMV、PSV、EDV水平低于无狭窄组，PI值高于无狭窄组，差异均有统计学意义(t=12.747、5.018、4.377、5.563、9.082，P均＜0.001)。ROC分析结果显示：肱动脉血流量诊断AVF并发头静脉吻合口狭窄的价值最高，曲线下面积(area under curve，AUC)为0.852(95%CI：0.769～ 0.936，P＜0.001)，灵敏度和特异度分别为56.76%、94.59%；其次是EDV、PSV、TAMV、PI的AUC分别为0.764(95%CI：0.650～0.877，P＜0.001)、0.756(95%CI：0.640～0.872，P＜0.001)、0.701(95%CI：0.583～0.818，P =0.003)、0.654(95%CI：0.518～0.790，P=0.023)。结论 采用彩色多普勒超声监测肱动脉血流参数对预测AVF并发头静脉吻合口狭窄具有重要价值。

Objective  To investigate brachial artery blood flow parameters assessed by color Doppler ultrasonography in the diagnosis of autologous arteriovenous fistula (AVF) complicated with cephalic vein anastomotic stenosis.  Methods  Ultrasonography was performed in 96 maintenance hemodialysis (MHD) patients with AVF. They were divided into cephalic vein anastomotic stenosis group (n=37) and non-stenosis group (n=59). Color Doppler ultrasonography was used to measure brachial artery time-averaged mean velocity (TAMV), pulsatile index (PI), resistance index (RI), peak systolic velocity (PSV), and end-diastolic velocity (EDV). These parameters were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the value of brachial artery blood flow parameters in the diagnosis of AVF complicated with cephalic venous anastomotic stenosis.  Results  There were no significant differences in brachial artery diameter and RI between the two groups (P＞0.05). Brachial artery blood flow, TAMV, PSV, and EDV in the stenosis group were lower than those in the non-stenosis group, and PI in the stenosis group was higher than that in the non-stenosis group (t=12.747, 5.018, 4.377, 5.563 and 9.082 respectively; P＜0.001). ROC curve showed that brachial artery blood flow had the highest value in the diagnosis of AVF complicated with cephalic venous anastomotic stenosis, the area under curve (AUC) was 0.852 (95% CI 0.769~0.936, P＜0.001), the sensitivity was 56.76%, and the specificity was 94.59%; the AUCs of EDV, PSV, TAMV and PI were 0.764 (95% CI 0.650～0.877, P＜0.001), 0.756 (95% CI 0.640～0.872, P＜0.001), 0.701 (95% CI 0.583～0.818, P=0.003), and 0.654 (95% CI 0.518～0.790, P=0.023) respectively.   Conclusion   Monitoring of brachial artery blood flow parameters by color Doppler ultrasonography is of great value in predicting AVF complicated with cephalic venous anastomotic stenosis.