三维彩色多普勒超声诊断移植肾急性排异反应

Three-dimensional color Doppler ultrasonography in evaluation of acute renal transplant rejection

目的观察移植肾急性排异反应发生后肾脏体积及血流灌注的变化规律,探讨三维彩色多普勒超声(3D-CDU)在诊断移植肾急性排异反应(AR)中的应用价值。方法应用三维超声表面成像原理及彩色血流重建技术,对正常组和急排组移植肾进行三维重建,并比较两组肾脏体积及血流灌注变化情况。结果急排组移植肾体积(179245.53±13143.65)mm3与正常组(140214.35±12854.13)mm3比较有明显增大(t=2.789,P<0.01);急排组肾脏体积与血肌酐浓度(Scr)呈正相关,且相关系数较高(r=0.73,P<0.05);在同一量程、中等滤波条件下对移植肾血流进行三维重建,急排组移植肾血流明显稀疏,末梢血管不能显示,血流分级集中于0～2级;正常组移植肾血流灌注丰富,"血管树"完整,各级肾动脉均清晰可见,血流分级集中于3～5级。结论移植肾急性排异发生后肾脏体积明显增大,肾血流灌注量减少,流速减低。三维彩色多普勒超声能够较为客观、准确的反映移植肾体积变化和肾内血流的灌注状况,对于移植肾急性排异反应的诊断具有一定的参考价值。

Objective To determine the value of three-dimensional color Doppler ultrasonography （3D-CDU） in monitoring the alteration of renal volume and arterial blood flow perfusion of transplanted kidney, and to assess the application value of 3D-CDU for the diagnosis of acute rejection. Methods Imaging of the normal and acute rejection transplanted kidney obtained with 3D-CDU were reconstructed, and the alteration of the volume and blood perfusion in both the rejection kidney and normal kidney groups were compared. Results The mean volume of the allografts expanded significantly in acute rejection group （179245.53± 13143.65） mm^3 compared with the control group （ 140214.35 ± 12854. 13） mm^3 （t = 2. 789, P,〈 0. 01）. The volume of the acute rejection allografts was well correlated with the blood creatinine in rejection group （r=0. 73, P〈0.05）. The blood vessel branches were disintegrated and the blood flow classification were mainly distributed in grade 0 -2 in acute rejection allograft groups, whereas the blood vessel branches were integrated and the blood flow classification were distributed in grade 3- 5 in the control group. The branched flow signals of the normal transplanted kidneys were sufficiently rich in blood and appeared with full of clear branches, compared with the rejection group. Conclusion 3D-CDU has been proven as an excellent tool for diagnosing renal acute allograft rejection, and is able to demonstrate the flow situation of kidney and reflect true kidney volumes changes for monitoring allograft rejection in kidney.