彩色多普勒超声对移植肾血流动力学的临床研究

Clinical study on hemodynamics in renal transplantation by color doppler sonography

目的 :应用彩色多普勒血流显像技术 ,观察移植肾皮质区的血流灌注 ,并测定其血流动力学参数 ,寻找诊断肾移植急性排异更敏感的指标。方法 :所用仪器为DiasonicsGateway彩色多普勒超声仪 ,探头频率分别为凸阵 / 3 .5MHz和线阵 / 1 0MHz,用CDE模式显示移植肾内各级血管并测定其血流动力学参数 ;用 1 0MHz探头分别用CDFI及CDE模式测定皮质区血流动力学参数并与血肌酐值作对比分析。结果 :移植肾急性排异时 ,①皮质区彩色血流显示减少 ;②皮质区动脉频谱收缩期峰高尖、舒张期无或少血流信号显示 ,呈单峰显示 ;③移植肾内各级动脉阻力指数明显增高 ;④与血肌酐值相比 ,皮质区血流动力学的变化诊断肾移植急性排异 ,具有更敏感、更可靠的价值。结论 :移植肾急性排异时CDFI上血流动力学的变化早于血肌酐值的变化 ,评价移植肾急性排异更敏感。

Objective:In this study color Doppler sonography was used to observe the blood perfusion in cortex of the transplanted kidney and measure the related hemodynamic parameter,in order to find a sensitive index for the diagnosis of the acute allograft rejection in renal transplantation.Methods:The equipment used was Diasonic Gateway color Doppler Ultrasound.The 3.5 MHz convex phased array transducer was used to demonstrate the blood flow in the vessels at different levels in the transplanted kidney,and measure hemodynamic parameters.The 10MHz linear phased array transducer was used to show the blood flow in the cortex of the transplanted kidney.Hemodynamic measurements were compared with the results of value of the creatinine clearance.Results:During the acute allograft rejection of the transplanted kidney the following could be detected:①the color blood flow display in the renal cortex decreased significantly.②in the renal cortex,the arterial systolic blood flow has high spectrum,sharp peak and symmetrical waveform while the diastolic flow does not display.③The different levels of resistant index of the renal arteries increased significantly.④Compared the measurement of the Creatinine (Cr) in the blood,the changes of the hemodynamic parameters in the renal cortex measured by Doppler Ultrasound was more sensitive and reliable in the diagnosis of acute transplantation rejection.Conclusion:During the acute rejection of transplanted kidney the hemodynamic changes demonstrated in CDFI appears earlier than the change of the blood creatinine clearance.It is reliable and more sensitive in diagnosis of acute rejection.It can be concluded that color Doppler sonography has very important clinical value in the early diagnosis of the acute rejection of the transplanted kidney and in the prediction of prognosis.