彩色多普勒超声对移植肾急性排斥反应的评价

Evaluation of acute renal allograft rejection using color Doppler ultrasound

目的:肾移植的成功与否关键在于及时发现和正确处理排斥反应。探讨无创伤性形态学和血流动力学检查手段彩色多普勒超声在移植肾急性排斥反应中的作用,为临床评估肾移植效果及移植肾功能提供客观的辅助性数据。方法:选择2004-01/2005-12在南京医科大学附属第一医院、江苏省人民医院行同种异体移植肾患者57例,其中经穿刺活检证实或最后临床诊断为急性移植肾排斥反应者22例,未发生排斥反应等并发症的移植肾功能正常者35例,患者均知情同意。采用Philips EnVisor彩色多普勒超声血流显像仪,对急性排斥反应肾移植患者进行二维超声和彩色多普勒血流显像检测,观察排斥反应患者甲基强的松龙冲击治疗前后移植肾脏的大小、形态结构、肾内血管树分布、血流灌注以及各级动脉血流参数(阻力指数,搏动指数)等指标的变化,并与移植肾功能正常患者进行比较。结果:急性排斥反应组2例患者发生严重并发症死亡,进入结果分析急性排斥反应组20例,移植肾功能正常组35例。①发生急性排斥反应时肾移植患者移植肾体积明显大于肾功能正常组(P<0.01);肾实质增厚,皮髓质界限模糊。给予甲基强的松龙冲击治疗后急性排斥反应组患者肾脏厚径显著小于治疗前(P<0.05);肾实质回声减低,皮髓质交界变清。②发生急性排斥反应时肾移植患者移植肾血流阻力指数、搏动指数均显著高于移植肾功能正常组(P<0.01)。治疗后急性排斥反应组患者肾血流阻力指数、搏动指数均显著低于治疗前(P<0.01),与移植肾功能正常组差异无显著性意义(P>0.05)。结论:彩色多普勒超声作为一种简便、经济的无创性技术,对移植肾血流阻力指数、搏动指数的追踪观察可为临床上评估肾移植效果提供较可靠的客观依据,对移植肾急性排斥反应的早期诊断有较高的评估价值。

AIM： The prompt discovery and correct management of the rejection is crucial for the renal transplantation. This study is designed to investigate the role of color Doppler ultrasound in the acute rejection following the renal transplantation by invasive morphology and hemodynamic examination, providing the adjuvant references for the clinical evaluation of the renal allograft. METHODS： The experiment was carried out among 57 patients underwent renal allograft transplantation in the First Affiliated Hospital of Nanjing Medical University （Jiangsu Province People＇s Hospital） from January 2004 to December 2005. All patients were informed and agreed to join the study. Among them, there were 22 cases with acute rejection confirmed by biopsy puncture or clinic manifestation, and 35 cases with normal renal allograft fur,ction. The sonographic features in 22 cases with acute rejection were inspected with two-dimensional ultrasound and color Doppler flow imaging before and after anti-rejection therapy, and contrasted with 35 cases normal renal allograft function. The parameters of renal size, morphology and structure, distribution of renal vascular trees, the resistive index （RI） and pulse index （PI） of main renal artery, segmental artery, and interlobar artery were observed. RESULTS： Two patients with acute rejection dies of the severe complication, so 20 acute rejection cases and 35 normal controls entered the result analysis. （1）Compared with control group, the renal size of allograft and thickness of renal cortex significantly increased in acute rejection group （P 〈 0.01）; and the margin of renal cortex and medulla became dim. Moreover the methyiprednisolone therapy could decrease the renal thickness and the resonance of renal cortex in patients of acute rejection （P 〈 0.05）; and the margin of renal cortex and medulla became distinct.（2）The renal artery RI and PI were significantly higher in acute rejection group than in normal allograft group （P 〈 0.01）, and the methylprednisolone therapy could also decrease the two indexes remarkably （P 〈 0.01）. CONCLUSION： Color Doppler ultrasound, as a convenient, economical and invasive technique, provides the reliable evidences for the renal artery RI and PI in clinics, and also is valuable for the acute rejection early diagnosis of renal allograft.