超声弹性成像在诊断移植肾急性排斥中的应用

Application of ultrasound elastography in diagnosis of acute rejection after renal transplantation

目的探讨超声弹性成像(UE)弥散定量分析技术对移植肾急性排斥反应的诊断价值。方法筛选55例接受同种异体肾移植手术患者,其中26例移植肾肾功能稳定(稳定组),29例发生移植肾急性排斥反应(排斥组),观察两组的二维超声、CDFI及UE声像图表现,并对两组超声定量数据行统计学分析。结果①与稳定组相比,排斥组移植肾体积及锥体高度增大、叶间动脉收缩期最大流速减低,阻力指数(RI)增高;ROC曲线分析获得叶间动脉RI的最佳诊断临界点为0.755,诊断敏感度、特异度及准确率分别为58.62%(17/29)、92.30%(24/26)及74.55%(41/55);②排斥组皮质应变均值(MEAN)小于稳定组,蓝色区域百分比(AREA%)大于稳定组,差异均有统计学意义(P均<0.05);③ROC曲线分析获得皮质MEAN最佳诊断临界点为88.25,诊断敏感度、特异度及准确率分别为75.86%(22/29)、96.15%(25/26)及85.45%(47/55)。结论 UE及其弥散定量分析技术可用于移植肾术后病情监测,有助于早期诊断移植肾急性排斥反应。

Objective To explore the value of ultrasound elastography （UE） dispersive quantitative analysis in diagnosis of acute rejection after renal transplantation. Methods Fifty-five patients after renal transplantion were included. There were 26 patients with stable renal function （SF group） and 29 patients with acute renal rejection （AR group）. All of them underwent two-dimensional ultrasound, CDFI and UE. Quantitative data between the two groups were analyzed statistical- ly. Results ①Compared to SF group, the renal volume enlarged, the pyramid height and RI of interlobar artery increased, and VP of interlobar artery decreased in AR group. Taking the cutoff value of RI deduced by ROC curve as 0. 755, the sen- sitivity, specificity, accuracy in diagnosing acute renal rejection was 58.62% （17/29）, 92.30% （24/26） and 74. 55% （41/ 55）, respectively.②The average hardness of cortex in AR group was less than that in SR group, and the percentage of hardness in AR group was higher than that in SR group （both P〈0.05）. ③Taking the cutoff value of average cortex hard- ness deduced by ROC as 88.25, the sensitivity, specificity and accuracy in diagnosing acute renal rejection was 75.86% （22/29）, 96.15% （25/26） and 85.45% （47/55）, respectively. Conclusion UE with dispersive quantitative analysis can be used to observe the patienfs condition after renal transplantation, and is helpful to diagnosis of acute renal allograft re- jection.