超声对肾综合征出血热肾动脉血流参数变化及血液流变学改变的对照分析

Comparative analysis of hemodynamics and hemorheology changes of haemorrhagic fever with renal syndrome by ultrasonography

目的观察肾综合征出血热(HFRS)患者肾内动脉血流动力学改变及血液流变学改变。方法选取我院经实验室检查及临床确诊为HFRS的患者272例(HFRS组),经彩色多普勒超声仪检测患者肾内动脉的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI);检测血液流变学的8项指标。并与同期210例健康者(正常对照组)相应检测项目进行对比分析。结果 HFRS组中,发热期时肾内血流频谱各项参数与正常对照组比较差异无统计学意义(P>0.05),血液流变学检测结果中全血黏度、红细胞压积均低于正常对照组(P<0.05);低血压休克、少尿期时肾动脉Vd、Vs低于正常对照组,RI明显高于正常对照组,且血液流变学各项参数亦改变明显,差异均有统计学意义(P<0.05);多尿期时肾动脉Vs、Vd均较低血压休克、少尿期有所回升,但其值仍低于正常对照组,且RI已接近正常对照组,此时除纤维蛋白原逐渐增加,血沉、血沉方程K值尚未降至正常,余均已恢复;恢复期时肾内血流各项参数均已恢复正常。结论 HFRS病程各期血流动力学参数和血液流变学参数均有一定的变化规律。超声检测肾内血流动力学具有特异性,可更直观地反映肾内血流情况。

Objective To observe the hemodynamics and hemorheology changes in patients with haemorrhagic fever with renal syndrome （HFRS）. Methods Two hundred and seventy-two patients with HFRS confirmed by clinical and laboratorial examination were enrolled in this study. Their peak systolic velocity （ Vs ） , end diastolic velocity （ Vd ） and resistance index （RI） of the renal artery were measured by color Doppler flow imaging （CDFI）, and hemorheology parameters were measured. The parameters of 210 healthy subjects （control group）were measured too, their results were compared and analyzed. Results There was no significant difference of CDFI parameters between two groups at fervescence stage （ P 〉 O. 05）, while the whole blood viscosity, polycythaemia compress volume in HFRS group were lower than those in control group （P 〈 0.05 ）, the Vd, Vs in HFRS group were lower and the RI was higher than that in control group at the stages of hypotensive shock and anuria （ P 〈 0.05 ） , obvious changes were also observed in hemorheology test. In diuresis stage, Vs and Vd were increased, but they are still lower than those in control group. RI was similar to that in control group. The hemorheology parameters returned to normal levels except the fibrinogen, blood sedimentation and erythrocyte sedimentation rate equation K＇ s value. In recovery stage, all hemodynamics and hemorheology parameters returned to normal levels. Conclusion The parameters of hemodynamics and hemorheology in various stages of HFRS have certain regularity. There is specific diagnostic value of color Doppler ultrasound in examining hemodynamic changes, and it can reflect the state of renal blood flow.