慢性移植肾损伤的组织弥散定量分析与血肌酐水平的相关性研究

Relationship between the quantitative analysis of tissue diffusion and the level of serum creatinine in chronic renal allograft injury

目的 探讨实时组织弹性成像（RTE）技术的组织弥散定量分析在慢性移植肾损伤的应用及与血肌酐水平的相关性.方法 同种异体肾移植患者69例,均行常规超声检查和实时组织弹性检查,按血肌酐水平及术后时间分为三组：术后3个月内肌酐正常组（A组,25例）、术后3个月以上高肌酐组（B组,23例）、术后3个月以上肌酐正常组（C组,21例）,并对结果进行对比分析.结果 ①A组与B组比较,血肌酐、组织弥散定量分析参数应变均值（MEAN）、蓝色领域（％AREA）、复杂度（COMP）、峰度（SKEW）、相关性（CO RR）差异有统计学意义（P＜0.05）.②B组血肌酐与组织弥散定量分析参数（MEAN、％AREA、SKEW）之间有相关性（r=0.682,P＜0.05;r=-0.628,P＜0.05;r=-0.481,P＜0.05）.③对组织弥散定量分析参数作ROC曲线,MEAN敏感性较高（90.9％）,COMP特异性、准确性较高（68.0％,81.8％）.④将结果三所得截点应用到C组,结果显示21例中有4～5例高于或低于截点.结论 RTE的组织弥散定量分析与血肌酐水平有良好的相关性,可以间接反映慢性移植肾损伤,是超声评价移植肾功能的新方法.

Objective To investigate the quantitative analysis of tissue diffusion of real-time elastography（RTE） in chronic renal allograft injury（CRAI） and the relationship between RTE and the level of serum creatinine（Cr）.Methods Sixty-nine cases of allograft renal transplantation patients were detected by conventional ultrasound and RTE.According to the time after operation and Cr,they were divided into three groups：group A （in three months after operation and normal Cr,25 cases）,group B （more than three months after operation and normal Cr,23 cases）,and group C （more than three months after operation and high Cr,21 cases）.The results were compared and analyzed.Results ①Contrast between group A and group B,there were differences on Cr and average ralative strain value（MEAN）,area ratio of low-strain region （% AREA）,complexity （COMP）,skewness （SKEW）,（P 〈 0.05）.② In group B,there was correlation between Cr and %AREA,MEAN,SKEW （r =0.682,P 〈0.05; r =0.628,P 〈0.05; r =-0.481,P 〈0.05）.③To make ROC curve,MEAN has higher sensitivity （90.9%）,COMP has higher specificity and accuracy （68.0%,81.8%）.④ To apply the third result in group C,4 or 5 cases in 21 were abnormal.Conclusions There is a good correlation between the quantitative analysis of tissue diffusion and the level of serum creatinine.RTE can indirectly reflect CRAI,and it is a new method of ultrasonic to evaluate renal allograft function.