超声造影评估慢性肾功能不全患者肾血流灌注的研究

Contrast-enhanced Ultrasound Assessment of Renal Perfusion in Patients with Chronic Renal Failure

目的探讨超声造影定量分析技术评估肾功能不全患者肾血流灌注的应用价值。资料与方法 36例慢性肾功能不全患者(研究组)及42例无肾脏疾病者(对照组)行超声造影检查,使用随机QLAB分析软件获取肾脏超声造影血流灌注时间-强度曲线(TIC)及相关参数[曲线下面积(AUC)、曲线上升支斜率(A)、峰值强度(PI)、达峰时间(TTP)、曲线下降支斜率(α)],并分析其与血肌酐(Scr)及尿素氮(BUN)水平的关系。结果研究组肾皮质血流灌注TIC上升、下降均缓慢,TTP延迟;与对照组比较,研究组肾皮质定量灌注参数中,AUC增大、PI减低、A增大、TTP延长(P<0.05)。AUC、TTP、A与Scr(r=0.89、0.73、0.70,P<0.05)、BUN(r=0.84、0.77、0.65,P<0.05)呈正相关,PI与Scr(r=-0.64,P<0.05)、BUN(r=-0.71,P<0.05)呈负相关;α与Scr(r=0.04,P>0.05)、BUN(r=0.05,P>0.05)无显著相关性。结论肾脏实时超声造影定量分析技术可实时观察肾皮质血流灌注过程,其定量灌注参数可反映慢性肾功能不全患者肾皮质血流灌注的真实水平,与Scr及BUN水平有良好的相关性。

Purpose To explore the value of contrast-enhanced ultrasound in assessing renal perfusion in patients with chronic renal failure.Materials and Methods Thirty-six patients with chronic renal failure（study group） and 42 subjects without kidney diseases（control group） underwent contrast-enhanced ultrasound.QLAB image analysis software was used to obtain time-intensity curves（TIC） and perfusion parameters,including area under curve（AUC）,slope rate of ascending curve（A）,peak intensity（PI）,time to peak（TTP）,slope rate of descending curve（α）;and the relationships between perfusion parameters and serum creatinine（Scr） and blood urea nitrogen（BUN） were also analyzed.Results In study group,renal cortex perfusion TIC showed slow ascending and descending;and TTP was delayed.Compared with control group,there were increased AUC and A,decreased PI,and delayed TTP in study group（P 〈0.05）.AUC,TTP and A showed positive correlations with Scr（r = 0.89,0.73,0.70,P 〈0.05） and BUN（r = 0.84,0.77,0.65,P〈 0.05）.PI was negatively correlated with Scr（r=-0.64,P〈0.05） and BUN（r =-0.71,P〈0.05）;the correlation between α and Scr as well as α and BUN was not statistically significant（r = 0.04,P〉 0.05;r = 0.05,P 〉0.05）.Conclusion Quantitative analysis of contrast-enhanced ultrasound demonstrates the blood flow process in renal cortical in real-time.It is useful to diagnose,monitor and follow up renal failure.