肾移植术后急性排斥反应的超声造影时间-强度曲线特征

Contrast-enhanced ultrasonography time-intensity curve characteristics in transplantation kidney allograft acute pyelonephritis

目的探讨肾移植术后急性排斥反应的CEUS时间-强度曲线(TIC)特征。方法选取经皮移植肾活检术确诊为急性排斥反应(AR)患者12例(AR组)、肾移植术后移植肾功能恢复良好的患者19例(SGF组)进行移植肾CEUS,于移植肾皮质区域内选取2个ROI进行TIC分析,主要指标包括:①时间:起始时间(AT-1,AT-2)、达峰时间(TTP-1,TTP-2)、绝对达峰时间(ATTP-1,ATTP-2)、廓清时间(WT-1,WT-2);②强度:起始强度(AI-1,AI-2)、峰值强度(PI-1,PI-2)、强度上升速度(Va-1,Va-2)、终末强度(TI-1,TI-2)、强度下降速度(Vd-1,Vd-2)、曲线下面积(AUC-1,AUC-2);③差异性:即同一移植肾2个ROI的TIC指标的差值,分别为起始强度差(AI1,2)、起始时间差(AT1,2)、峰值强度差(PI1,2)、达峰时间差(TTP1,2)、绝对达峰时间差(ATTP1,2)、廓清时间差(WT1,2)、曲线下面积差(AUC1,2)。对两组以上指标进行统计学分析。结果AR组ATTP-1、ATTP-2均长于SGF组(P均<0.05);AR组Va-1、Va-2均慢于GRS组(P均<0.05);2个ROI的TIC差异性指标在两组间差异无统计学意义(P均>0.05)。两组造影剂分布均匀和不均匀者差异有统计学意义(P<0.01)。结论AR患者移植肾皮质区CEUS TIC的ATTP延长、Va减慢,表现为TIC峰圆顿、上升支斜率增大。TIC可较好地反映移植肾微循环的情况,且不受ROI的影响,对早期诊断肾移植术后AR具有一定价值。

Objective To analyze the time-intensity curve （TIC） characteristics of CEUS in transplantation kidney al- lograft acute pyelonephritis. Methods Twelve patients diagnosed as acute rejection （AR group） by percutaneous kidney allograft biopsy and 19 patients with stable graft function （SGF group） after kidney transplantation were enrolled. CEUS of allograft and analysis of TIC characteristics were performed by selecting two different ROIs in the same allograft. TIC in- dex included.. （1）Time index.. Arrival time （AT-l, AT-2）, time to peak （TTP-1, TTP-2）, absolutely time to peak （AT- TP-1, ATTP-2）, wish-out time （WT-1, WT-2） ; （2）Intensity index.. Arrival intensity （AI-1, AI-2）, peak intensity （PI-1, PI-2）, velocity of intensity ascending （Va-1, Va-2）, terminal strength （TI-1, TI-2）, velocity of intensity descending （Vd- 1,Vd-2）, the area under the curve （AUC-1, AUC-2）; （3）Divergence index.. Divergence of the same TIC index in two ROIs, including divergence in arrival intensity （AI1, 2）, arrival time （AT1, 2）, peak intensity （PI1, 2）, time to peak （TTP1, 2）, absolutely time to peak （ATTP1, 2）, wish-out time （WT1, 2）, the area under the curve （AUC1, 2）. All indexes were statistical analyzed in both groups. Results ATTP-1 and ATTP-2 in AR group were longer than that of SGF group （all P〈0.05） ; Va-1 and Va-2 in AR group were slower than that of SGF group （all P〈0.05） ; and the divergence of ROI was not statistically significant （all P〉0.05）. The contrast media distribution in both groups had no statistical difference （P〈0.01）. Conclusion The characteristics of cortical areas TIC in AR patients include longer ATTP and slower Va, as well as round peak of TIC and slope increase in ascending. Those indexes can better reflect the microcirculation in allograft of AR, not affected by ROI selection, therefore having clinical value in diagnosis of AR in patients after kidney transplantation.