超声造影对弥漫性肾病肾血流灌注的评价

Perfusion of diffuse nephropathy: gray scale contrast-enhanced ultrasound evaluation

目的探讨实时灰阶超声造影评价弥漫性肾病血流灌注改变的临床价值。方法选取对照组(健康人24例)和病例组(弥漫性肾病患者25例),对所有受检者造影前1d检测血清肌酐(Cr)、尿素氮(BUN)。经静脉团注SonoVue(0.03ml/kg)行肾脏灰阶超声造影,观察并存储注射造影剂后0～3min的动态图像,利用定量分析软件进行离机时间-强度曲线(TIC)分析,分别计算两组肾皮质达峰时间(ATc)、皮质峰值强度变化(△Ac)、皮质TIC斜率(βc)、髓质达峰时间(ATm)、髓质峰值强度变化(△Am)、髓质TIC斜率(βm)、髓质皮质达峰时间之差(△AT)、皮质髓质峰值强度变化值之差(△Ac-m)。对以上检测结果进行统计学分析,并研究上述参数与血BUN和Cr值相关性。结果两组肾脏ATc、ATm、βc差异有统计学意义(P<0.05),与TIC曲线形态结果一致;病例组△AT较对照组有延长趋势;ATm、△AT与BUN、Cr呈正相关(r=0.68、r=0.66、r=0.71、r=0.69,P均<0.05)。结论超声造影技术可较敏感反映弥漫性肾病肾脏血流灌注变化特点,有望成为评价肾血流灌注的临床实用技术。

Objective The purpose of this research was to determine the feasibility of gray scale contrast-enhanced ultrasound for the evaluation of renal perfusion in patients with diffuse nephropathy. Methods The control group (normal) and patient group (diffuse nephropathy) were selected, kidney function tests such as blood BUN and Cr were detected before US scanning, then bolus SonoVue injection (0.03 ml/kg) and gray scale contrast-enhanced sonography were performed. Sonographic images were captured continuously for a total of 3 minutes after injection. Sonographic renal perfusion images were converted into a renal perfusion time-intensity curve (TIC) by the quantitative analyzing software. Furthermore, the parameters such as △A (peak back scattering intensity change)(△A=PI-BI, peak back scattering intensity-basic scattering intensity), AT(accelerating time), β(slope rate of the TIC), △AT(ATm-ATc, m=medulla, c=cortex), △Ac-m(△Ac-△Am) were calculated. The indices of the two groups and the relationship with BUN and Cr were analysed. Results ATc, ATm, and βc of the two groups had significant difference(P<0.05),concordant with the TIC. △AT of the patient group was prolonged contrast to the normal group. △Ac-m, βm, △Ac, △Am of the two groups had no difference. The correlation coefficient of ATc, ATm, βc, △AT with BUN was 0.15 (P>0.05),0.68 (P<0.05), 0.18 (P>0.05), 0.66 (P<0.05) respectively, the correlation coefficient with Cr was 0.12 (P>0.05), 0.71(P<0.05), 0.01(P>0.05), 0.69(P<0.05) respectively; that means ATm and △AT had some association with BUN and Cr. Conclusions The renal perfusion TIC obtained from new gray scale contrast enhanced ultrasound may be a sensitive sonographic technique for the evaluation of diffuse nephropathy.