二维超声、频谱及彩色多普勒超声在评价实验性兔急性肾衰竭中的价值比较

Comparison of diagnostic value of duplex and color Doppler ultrasound in experimental acute renal failure in rabbits

目的 比较二维超声、频谱及彩色多普勒超声在诊断急性肾衰竭 (ARF)中的价值。方法 兔后腿肌注 5 0 %甘油 12～ 15ml/kg ,建立ARF动物模型 ,分别于给药前 (T0 )、给药后 1、3… 13d(T1、T3…T13)共 8个时间点行超声检查 ,二维超声用于观察肾脏大小及回声改变 ,频谱多普勒用于定量分析肾血流动力学改变 ,彩色多普勒血流显像 (CDFI)及彩色多普勒能量显像 (CDPI)用于定性分析肾血流灌注情况 ,将肾血流情况分为 3级 :Ⅰ级 ,肾血流灌注正常 ,血流信号可延至肾包膜下 ;Ⅱ级 ,肾血流灌注不良 ,血流信号可延至肾皮质 ,但不能至肾包膜下 ;Ⅲ级 ,肾血流灌注重度不良 ,血流信号不能延至肾皮质。结果 肾脏大小及肾血流动力学改变均从T3 开始 ,T5、T7达高峰 ,T9时多已恢复至正常 ,且肾皮质增厚与肾体积增大高度相关。T0 时所有兔肾CDFI及CDPI均表现为Ⅰ级 ,T1～T9各时相所有兔CDFI均为Ⅲ级 ,T11、T13 时多数仅恢复至Ⅱ级。T1、T3 时CDPI均为Ⅱ级 ,T5、T7时仅少数发展为Ⅲ级 ,T11时多数恢复至Ⅰ级。结论 ARF时 ,高分辨力二维超声在显示肾皮质回声改变及皮质厚度的精确测量上有较高价值 ;频谱多普勒有助于定量分析肾血流动力学改变 ;在显示肾血流灌注的改变上 。

Objective To compare the diagnostic value of two dimentional ultrasound, spectrum and color Doppler ultrasound in experimental acute renal failure(ARF) in rabbits.Methods 50% glycerin (12～15 ml/kg ) were injected into the thigh muscle of the back leg of the rabbit to induce an animal model of ARF. Ultrasonic examination was performed on the day before (T 0) and days 1,3…13 after the injection(T 1,T 3…T 13 ). Renal size was evaluated by two dimensional ultrasound. The hemodynamic changes of the kidney were quantitatively analysed by spectrum Doppler,while color Doppler flow imaging(CDFI) and color Doppler power imaging(CDPI) were used to qualitatively study the blood perfusion of the kidney during ARF. The renal imaging in CDFI and CDPI were classified three grades.Grade Ⅰ,the blood perfusion of the kidney was normal and the flow singles could be seen at the site near to the renal capsule. Grade Ⅱ,the blood perfusion of the kidney was slightly abnormal and the flow singles could be seen in the renal cortex but not near to the capsule.Grade Ⅲ,the blood perfusion was heavily abnormal and the flow singles could not be seen in the renal cortex.Results The changes of renal hemodynamics and renal size began at T 3,peaked at T 5 and T 7,and returned to normal at T 9.The renal imaging of all rabbits were grade Ⅰ in CDPI and CDFI at T 0.In CDFI,all were grade Ⅲ at T 1～T 9,at T 11 and T 13 most of them only returned to grade Ⅱ,no one returned to grade Ⅰ.In CDPI, however, all were grade Ⅱ at T 1 and T 3, while only a few were grade Ⅲ at T 5 and T 7, and most have returned to grade Ⅰ at T 9.Conclusions During the period of ARF, two dimensional ultrasound is useful in showing the echo and measuring the depth of renal cortex. Spectrum Doppler is helpful in quantitatively analysing the renal hemodynamic changes. CDPI is more sensitive than CDFI in showing the blood perfusion of the kidney