声触诊组织定量技术在系膜增生型IgA肾病诊断中的应用

Preliminary application of virtual touch tissue quantification imaging in diagnosis of IgA nephropathy

目的探讨声触诊组织定量技术(VTQ)对系膜增生型IgA肾病的诊断价值。方法收集2013年12月至2014年7月在首都医科大学附属北京朝阳医院肾内科住院,被诊断为IgA肾病的患者85例,排除病情危重者、无法配合检查者、病理类型为非系膜细胞增生性IgA肾病者,最终入组54例系膜细胞增生型IgA肾病患者,108个肾脏。选取体检的健康志愿者54例,共计108个肾脏,作为健康对照组。使用VTQ技术分别测量健康对照组与系膜细胞增生型IgA肾病患者双肾中部肾实质及集合系统VTQ的SWV值,并进行比较。结果健康对照组双肾中部肾实质与集合系统的SWV值分别为(2.13±0.13)m/s、(1.15±0.02)m/s;IgA肾病组双肾中部肾实质与集合系统的SWV值分别为(3.07±0.62)m/s、(1.12±0.29)m/s。健康对照组肾实质与IgA肾病组肾实质SWV值比较,差异有统计学意义(t=-14.481,P<0.001),健康对照组肾集合系统与IgA肾病组集合系统SWV值比较,差异无统计学意义(t=0.82,P>0.05);健康对照组肾实质与集合系统SWV值比较,差异有统计学意义(t=-54.01,P<0.01);IgA肾病组肾实质与集合系统SWV值比较,差异有统计学意义(t=26.09,P<0.01)。伴随肾功能不全的加重,慢性肾病患者肾实质SWV值呈递增趋势(F=798.70,P<0.001)。叶间动脉阻力指数随慢性肾病1、2、3、4期逐渐增大。结论 VTQ技术对评价IgA肾病肾功能损害程度有一定诊断价值,为早期提示肾功能减低及判断其临床分期提供一个新的观察指标。

Objective To evaluate the value of virtual touch quantization （VTQ） imaging in diagnosis of IgA nephropathy. Methods The clinical data of 85 patients with IgA nephropathy were analyzed, who were treated in Capital Medical University Affiliate Beijing Chaoyang Hospital from December 2013 to July 2014. The patients who was with critical condition, unable to cooperate and with other pathological types were excluded. Finally 108 kidneys of IgA nephropathy with mesangial cell hyperplasia in 54 cases were included into the study. Meanwhile 108 kidneys in 54 volunteers who took the health physical examination in our hospital were taken as healthy controls. VTQ was performed in middle part of kidney and the measurements of shear wave velocity （SWV） was recorded. The mean SWV of renal parenchyma and collecting system was compared in different groups. Results The mean SWV measurement of renal parenchyma and collecting system in control group were （2.13±0.13） m/s, （1.15±0.02） m/s;the results in IgA nephropathy group were （3.07±0.62） m/s, （1.12±0.29） m/s. The mean SWV of renal collecting system was lower than that of renal parenchyma （t=-14.481, P〈0.001）. The mean SWV of renal parenchyma and collecting system in IgA Nephropathy group was higher than that in control group （t=-54.01, P〈0.001）. The renal parenchyma VTQ value positively correlated with the degree of renal insufficiency for patients with chronic kidney disease （CKD） （F=798.70, P〈0.001）. The interlobular arterial resistance index （RI） increased gradually with CKD stage, but no statistical differences were found. Conclusion In terms of early diagnosis and clinical staging, VTQ technology has some diagnostic value in evaluation of renal parenchymal damage for patients with IgA nephropathy.