多普勒超声监测肝硬化患者肾动脉阻力指数的临床意义

Doppler Ultrasonography for the Detection of Renal Arterial Resistive Index in Patients with Liver Cirrhosis: Its Clinical Significance

背景:肝硬化患者易发生肾脏血流灌注减少,导致肾功能损害。早期发现肾血流动力学的变化将有利于肝肾综合征的防治。目的:探讨不同阶段肝硬化患者肾血流动力学的变化,评价肾动脉阻力指数(RI)用于判断肝硬化患者早期肾功能损害的价值。方法:应用多普勒超声监测40例肝硬化患者和15名健康对照者的各级肾动脉RI。结果:肝硬化患者的各级肾动脉RI均较对照组显著增高(P<0.05),而血清肌酐、尿素氮水平与对照组相比无显著差异。大量腹水组肝硬化患者肾动脉主干、段动脉和皮质肾动脉的RI较少量腹水组和无腹水组显著增高(P<0.05),肾动脉RI由肾门至肾皮质依次降低的规律消失。结论:多普勒超声可在肝硬化患者血清肌酐、尿素氮水平增高前定量观察到肾血流动力学的变化。肾动脉RI可作为判断肝硬化患者早期肾功能损害较敏感的指标。

Background: Decreased renal perfusion is commonly present in patients with liver cirrhosis, and may lead to renal function impairment. Hence, early detection of impaired renal hemodynamics can contribute to the prevention and treatment of hepatorenal syndrome. Aims: To appraise the impairment of renal hemodynamics in patients with liver cirrhosis of different stages, and to assess the value of renal arterial resistive index (RI) in reflecting early impairment of renal function. Methods: The RI of renal arterial branches was measured in 40 cirrhotic patients and 15 healthy controls by Doppler ultrasonography. Results: RI in cirrhotic patients was significantly increased as compared with those in the controls (P<0.05), while no difference could be found at the levels of serum creatinine and urea nitrogen between the two groups. Cirrhotic patients with massive ascites had significantly increased RI of the main, segmental and cortical renal arteries as compared with those of the mild or non-ascitic cirrhotic patients (P<0.05). The rule of successive decrease in renal arterial RI from renal hilum to renal cortex disappeared. Conclusions: The impairment of renal hemodynamics in cirrhotic patients can be determined quantitatively by Doppler ultrasonography before the elevation of serum creatinine and urea nitrogen. Renal arterial RI is a sensitive index which can reflect the early impairment of renal function in cirrhotic patients.