移植肾彩色多普勒血流超声与肾穿刺活检的对照研究

Comparative study on color Doppler flow imaging with renal biopsies in transplanted kin deys

目的和方法：将彩色多普勒血流超声（ＣＤＦＩ）与移植肾活检结果相对照，评价无创性ＣＤＦＩ对移植肾排异反应的诊断价值．结果：不同病理状态下移植肾的阻力指数（ＲＩ）有所不同．急性排异和慢性排异反应组的ＲＩ值（０７８±００６）明显高于正常组（０５５±００７）（Ｐ＜００１）．两次肾活检提示由急性排异转为慢性排异反应的同一患者，ＣＤＦＩ的动态观察显示，ＲＩ值明显增高（００１＜Ｐ＜００５）．环孢素中毒患者的ＲＩ正常．结论：应用ＣＤＦＩ监测肾移植后的排异反应有应用价值．ＲＩ≥０６时，移植肾可能存在急性或慢性排异反应；ＲＩ≥０７，应高度怀疑存在慢性排异反应；ＲＩ≥０８时，急性排异的可能性增大．

Aim and methods:Combining color Doppler flow imaging(CDFI) and renal allograft biopsies,we evaluated noninvasive CDF lin diagnosing rejections of renal transplants. Results:Differences of resistive indexes(RI) in transplanted kidneys indicated their pathological changes. The RI values for acute and chronic rejection group were obviously higher than those for the normal(0.55±0.07)(P<0.01). For those patients with twice biopsies,it was proved that acute rejection was converted into chronic rejection,the dynamic observations on CDFI showed that RI values distinctly increased(0.01<P<0.05). The RIs for the patients with toxic reaction to cyclosporine A were normal. Conclusion:This study demonstrates that it is very important to apply CDFI in monitoring rejection of renal transplantation. When RI≥070, it should be highly suspected that chronic rejection exists in transplanted kidneys. When RI≥0.80, the probability of acute rejection increases. CDFI has a great significance in differentiating and diagnosing the toxic reaction to cyclosporine A, rejections and acute tubular necrosis.