彩色多普勒超声在肾移植术后AR与ATN鉴别诊断中应用

Application of color Doppler sonography in the differential diagnosis of acute rejection and acute tubular necrosis after renal transplant

目的：探讨彩色多普勒超声对肾移植术后急性排斥反应（AR）与急性肾小管坏死（ATN）鉴别诊断的价值。方法：选取2000年1月-2007年12月的肾移植患者135例，分为功能正常组、AR组和ATN组行彩色多普勒超声检查，观察移植肾形态结构、血流灌注及血流指数变化并作比较。结果：AR组移植肾长径、实质厚度较功能正常组明显增大（P〈0．01）；而ATN组移植肾长径、实质厚度较功能正常组略有增大，差别无明显统计学意义（P〈0．05）。AR组和ATN组阻力指数（RI）明显高于功能正常组（P〈0．01），而AR组和ATN组之间差别无统计学意义（P〉0．05）。结论：彩色多普勒超声测得移植肾RI和其他血流动力学变化不能用作鉴别AR和ATN的绝对依据，需要综合移植肾声像图改变来协助鉴别AR和ATN。

Objective： To evaluate the application of color Doppler sonography in differential diagnosis between post transplant acute rejection（AR） and acute tubular necrosis （ATN）. Methods：A total of 135 cases of renal transplant were grouped as normal functiop, AR and ATN. All patients were examined on transplanted kidney by color Doppler sonography, the length, blood flow and renal artery flow parameters of transplanted kidney were researched and compared. Results： In AR group, the length and parenchymal thickness of AR group are significantly longer than that of normal function group （ P 〉 0.01）. While the length and parenchymal thickness of ATN group are a little longer than that of normal group, but there is no difference between two groups （ P 〈 0.05）. RI of AR and ATN group was obviously higher than that of normal group （ P 〈 0.01）, but there is no difference between AR and ATN group （ P 〉 0.05）. Condusion： RI and other bemodynamic changes in transplanted examined color Doppler sonngraphy couldn＇ t be taken as the base for differentiating AR and ATN, other sonography changes should be needed.