SonoVue用子单侧肾积水肾功能变化的实验研究

Experimental Study of Renal Function Changes in Unilateral Hydronephrosis by Intravenous Injection of SonoVue

目的经静脉声学造影并进行声学定量检测兔单侧积水肾皮质的血流参数,旨在找出肾积水后肾功能变化特点,为更好地评价肾积水肾功能状况及治疗提供依据。方法将16只健康的新西兰大白兔制成右肾积水模型。采用超声造影剂SonoVue、TechnosDU6超声仪和CnTI适时造影成像技术进行造影增强超声检测积水肾皮质的皮质的峰值强度时间(PIT)、灌注曲线下面积(AUC)、肾实质造影增强平均通过时间(MTT)。分别于手术前及手术后2、4、6、8、10、12周通过造影测量肾皮质血流参数,第10、12周分别给第2、7号兔解除梗阻,1周后作相同检测。分别于4、8、10、12周时各处死16、15、14、13号实验兔,采集右肾组织病理检查。结果以手术前血流参数为基础对照:4、8、12周时AUC、MTT均降低(P<0.05),PIT延长(P<0.05)。组间对照结果:除2、4周组间对照AUC、MTT、PIT没有差别外(P>0.05)),其余各组间对照的AUC、MTT、PIT均有统计学意义。第10周时解除梗阻1周后,AUC、MTT较同期均增高,PIT缩短;第12周时解除梗阻1周后,参数AUC、MTT、PIT与12周时相比无变化。结论完全性尿路梗阻导致肾盂积水经SonoVue超声造影剂检测发现AUC小于15、PIT大于64s及MTT小于153s时,患肾功能进入不可逆期。尿路梗阻导致肾盂积水小于12周,应该尽早解除梗阻,有恢复患肾功能的机会。完全性尿路梗阻导致肾盂积水大于12周者,预后不良。

Objective To study the renal function changes nous injecting ultrasound contrast agent and acquiring blood flow after the rabbits right hydronephrosis by intraveparameters of renal cortex. Giving clinical doctors a better method to evaluate and cure hydronephrosis. Methods Sixteen white rabbits were operated to make obstructive hydronephrosis models. New contrast agent, SonoVue, Technos DU6 and Comrast Tuned Imaging（CnTI） technique were adopted to acquire Peak Intensity Time （PIT） ,Area Under the Curve （AUC） and Mean-transit time （MTT）. Before and after operation at 2,4,6,8,10,12 weeks, ultrasound contrast agent were performed to observe renal cortex flow changes. Ureter obstruction of rabbits 2 and 7 were relieved at 10 and 12weeks,repeated the same method after a week. Rabbit 16,15,14,13 were killed at 4,8,10,12 weeks. Results Compared to those before operation,AUC and MTT of renal cortex after intravenous administration contrast agent were obviously decreased and PIT was increased （P〈0.05 ）. There were no significant difference between 2 and 4 weeks. All the other groups had the statistic difference. Compared with 10 weeks,AUC and MTT of renal cortex after intravenous administration contrast agent of rabbit 2 which ureter obstruction was relieved at the 10th week were increased significantly and PIT was decreased. Compared with the 12th week by the same method,AUC,MTT and PIT of rabbit 7 had no changes. All the right kidneys were performed and compared with pathology. Conclusion The intravenous administration of SonoVue can be used for hydronephrosis by measuring time-intensity curve parameters such as AUC,MTT and PIT. While hydronephrosis is in progress,massive parenchymal lesion occurs in kidney if AUC is below 15. Ureter obstruction should be relieved before 12 weeks. After 12 weeks, the impairment of renal function may be completely irretrievable.