超声造影定量评估大动脉炎性肾动脉炎患者肾皮质血流灌注的价值

Value of contrast-enhanced ultrasound in quantitatively assessing renal cortical perfusion in patients with Takayasu arteritis-induced renal arteritis

目的探讨超声造影定量分析技术评估大动脉炎性肾动脉炎(TARA)患者肾皮质血流灌注情况的临床价值。方法选取我院临床确诊为TARA患者21例(TARA组,42个肾)和排除肾脏、心脏或血管疾病的患者22例(对照组,44个肾),应用超声造影定量分析技术获取两组肾皮质血流灌注的时间-强度曲线及相关参数,包括曲线下面积(AUC)、上升支斜率(A)、峰值强度(PI)、达峰时间(TTP)和平均渡越时间(MTT),比较两组上述各参数的差异,并分析其与肾小球滤过率(GFR)间的相关性。结果经CTA或DSA证实,TARA组42支肾动脉中26支存在管腔狭窄,归为患侧肾;16支无管腔狭窄,归为健侧肾。与对照组比较,TARA组患侧肾的AUC和A减小,PI降低,TTP和MTT增大,差异均有统计学意义(均P<0.05);TARA组健侧肾的A减小,TTP增大,差异均有统计学意义(均P<0.05)。相关性分析显示,AUC、A、PI与GFR均呈正相关(r=0.755、0.743、0.695,均P<0.05),TTP、MTT与GFR均呈负相关(r=-0.707、-0.731,均P<0.05)。结论超声造影定量分析技术可准确评估TARA患者肾皮质血流灌注情况,其灌注参数与肾功能评价指标的相关性良好,具有一定的临床应用价值。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)in quantitatively assessing renal cortical perfusion in patients with Takayasu arteritis-induced renal arteritis(TARA).Methods Twenty-one patients diagnosed with TARA in our hospital were selected as TARA group(42 kidneys),22 subjects without kidney diseases or cardiovascular diseases were enrolled as a control group(44 kidneys).CEUS were performed to all subjects to quantitatively analyze renal cortical perfusion,then the time-intensity curve and related parameters were obtained,including the area under the curve(AUC),the slope rate of ascending curve(A),the peak intensity(PI),the time to peak intensity(TTP)and the mean transit time(MTT).The differences of above parameters between two groups were analyzed.The relationships between the parameters and glomerular filtration rate(GFR)were analyzed.Results Confirmed by CTA or DSA,26 kidneys with renal artery stenosis in the TARA group were defined as the affected side.The other 16 kidneys without renal artery stenosis were defined as the healthy side.Compared with the control group,the AUC and A of the affected kidney in the TARA group were decreased,the PI was decreased,and the TTP and MTT were increased,and the differences were statistically significant(all P<0.05).The A of the healthy kidney in the TARA group was decreased,TTP was increased,and the difference were statistically significant(all P<0.05).Correlation analysis showed that AUC,A and PI were positively correlated with GFR(r=0.755,0.743,0.695,all P<0.05),while TTP and MTT were negatively correlated with GFR(r=-0.707,-0.731,both P<0.05).Conclusion CEUS quantitative analysis can accurately assess renal cortical perfusion in TARA patients,the quantitative perfusion parameters have a good correlation with renal function and have certain clinical application value.