胡桃夹综合征合并肾脏器质性病变的超声诊断与临床研究

Research of clinical and ultrasound diagnosis in nutcracker syndrome combining renal organic disease

目的 :探讨胡桃夹综合征(nutcracker syndrome,NCS)合并肾脏器质性病变的超声诊断价值,提高对NCS及合并症的诊断水平。方法:收集16例NCS,应用二维超声、CDFI、频谱多普勒、能量多普勒血流显像探查腹主动脉、肠系膜上动脉与左肾静脉的位置关系。平卧位及脊柱后伸位分别测量肠系膜上动脉和腹主动脉夹角、左肾静脉受压段管腔前后径(a)和血流速度Va;扩张段管腔前后径(b)和血流速度Vb。以DSA检查结果作为对照,分析超声诊断NCS的灵敏度和漏诊率。结果:超声诊断NCS的灵敏度为87.50%,漏诊率为12.50%。16例NCS中单纯NCS 3例(18.75%);合并肾脏器质性病变13例(81.25%),其中,Ig A肾病6例(37.50%),慢性肾小球肾炎3例(18.75%),微小病变肾病2例(12.50%),膜性肾病1例(6.25%),胡桃夹现象(nut cracker phenomenom,NCP)1例(6.25%)。结论 :超声是诊断NCS的首选影像学检查方法。临床医师应密切关注NCS患者24 h蛋白尿指标,及时行肾穿刺活检,准确诊断NCS合并肾脏器质性病变。

Objective ：To evaluate the diagnostic value of color Doppler ultrasound in nutcracker syndrome,to analyze the CDFI of the combining renal organic disease,and improve the diagnostic level of NCS and the complication. Methods：By Two-dimensional,color Doppler flow imaging,pulsed wave Doppler,power Doppler ultrasonography,to ascertain position relation of abdominal aorta,superior mesenteric artery and left renal vein,then inner-diameter of the narrow （a） and blood flow velocity （Va） ,dilated （b） and blood flow velocity （Vb） portion of the compressed left renal vein was measured. To repeat measuring a, Va and b,Vb after extending back on standing position. As a gold standard with result of DSA,sensitivity and false negative rate of nutcracker syndrome were calculated by transabdominal ultrasound. The incidence rate of combining renal organic dis- ease and A p was calculated too. very well laboratory examination and renal puncture biopsy and DSA. Results：the diagnostic value of color Doppler ultrasound in NCS：Sensitivity was 87.5%,false negative rate was 12.5%. Among nutcracker syndrome cases,simple nutcracker syndrome accounted for 18.8% （3/16）;combined IgA nephropathy accounted for 37.5% （6/16）;combined chronic glomerulonephritis accounted for 18.8% （3/16）;combined minimal change nephropathy accounted for 12.5% （2/16）; combined membranous nephropathy accounted for 6.3% （1/16）;nut cracker phenomenom accounted for 6.3% （1/16）. combined renal organic disease accounted for 81.2% （13/16）. Conclusion：Transabdominal ultrasound can be used as the preferred method for clinical diagnosis of nutcracker syndrome. Clinician should show solicitude for urine protein quantity in 24 hour of patient with nutcracker syndrome,perform renal puncture biopsy on time,and diagnose nutcracker syndrome accurately with combining renal organic disease.