兔急性肾功能衰竭时肾实质背向散射积分与病理对照的实验研究

Relationship between integrated backscatter and pathological changes of renal cortex during acute renal failure in rabbits

目的 探讨兔急性肾功能衰竭 (ARF)时肾实质背向散射积分 (IBS)的变化情况及其与病理改变的关系。方法 兔后腿肌注 5 0 %的甘油 12～ 15ml/kg ,建立急性肾小管坏死性ARF动物模型 ,分别于注射前(T0 )、注射后 1、3… 13d(T1、T3 …T13 )共 8个时间点行超声检查 ,测定肾皮质、肾髓质及肾窦区IBS值 ,分别以肾皮质IBS、肾髓质IBS与肾窦区IBS之比为肾皮质、肾髓质校正IBS值 (IBS % )。将测定结果与病理结果进行对比分析。结果 肾皮质IBS %从T3 开始明显升高 ,T7达高峰 ,T13 时尚未恢复至正常。T3 以后各时间点肾皮质IBS %与正常者相比均有显著性差异 ( P <0 .0 5 )。肾髓质IBS %改变不明显。肾脏病理改变主要在皮质部 ,髓质较轻 ,从T1开始 ,T7、T9达高峰 ,以后有所减轻 ,但到T13 时病变仍很明显 ,主要包括肾小管内大量管型形成 ,肾小管上皮细胞肿胀、坏死、脱落 ,肾间质水肿等。结论 急性肾小管坏死性ARF时 ,肾皮质IBS %明显升高 ,与病变程度密切相关 ,肾髓质IBS %无明显改变。ARF时肾皮质IBS %升高与多种病理因素有关。

Objective To investigate the changes of integrated backscatter (IBS) of renal cortex and explore their relation to pathological changes of renal cortex during acute renal failure (ARF) in rabbits.Methods The model of ARF was established in rabbits through the intramuscular injection of 50% glycerin (12～15 ml/kg) into the hind leg. Ultrasonic examination was performed on the day before (T 0) and days 1, 3…13 after the injection (T 1,T 3…T 13 ) to measure the IBS of the renal cortex, medulla and sinus. The ratios of IBS of the renal cortex and that of medulla to that of sinus were regarded as the revised IBS (IBS%) of the renal cortex and medulla. Then a correlative analysis was conducted between the IBS% and pathological changes in the renal cortex and medulla.Results The significant increase of IBS% of the renal cortex appeared at T 3, peaked at T 7 and remained abnormal still at T 13 ( P < 0.05 ). However, no significant change in IBS% of renal medulla was found. Pathological changes were mainly found in the renal cortex :① casts forming in the renal tubule;② swelling, necrosis and defluxion of the renal tubular epithelial cells;③ renal interstitial edema. These changes occured at T 1, peaked at T 7 and T 9 and remained abnormal at T 13 .Conclusions During ARF, IBS% of the renal cortex is significantly increased,which is closely related to the degree of renal cortical pathological changes. There is no significant change in the IBS% of the renal medulla. The increase in IBS% of the renal cortex during ARF is related to various pathological factors.