彩色多普勒超声与核素肾动态显像法评估梗阻性肾积水肾功能的对比研究

APPRAISEMENT OF COLOR DOPPLER ULTRASONOGRAPHY AND NUCLIDE NEPHRO-DYNAMICIMAGING ON FUNCTION OF THE OBSTRUCTIVE HYDRONEPHROSIS

目的应用ROC曲线法比较彩色多普勒超声与核素肾动态显像法评估单侧梗阻性中度或重度肾积水患者肾功能的临床价值。方法收集2014年6月—2015年6月,石家庄市第一医院收治的单侧梗阻性中度或重度肾积水患者57例,根据肾穿刺造瘘后24h引流量分为肾积水无功能组（30例）与有功能组（27例）。采用彩色多普勒超声测定肾内血流阻力指数（RI）,核素肾动态显像测定患肾肾小球滤过率（GFR）评估肾功能的诊断价值。结果肾无功能组和肾有功能组RI分别为0.87±0.06和0.75±0.09,差异有统计学意义（t=-6.92,P=0.001）;GFR分别为（8.96±6.34）ml/min和（24.80±12.50）ml/min,差异有统计学意义（t=-5.21,P=0.001）。RI和GFR诊断肾功能的ROC曲线下面积均大于标准参考曲线下面积;RI和GFR评估肾功能的曲线下面积及95%CI分别为0.924（0.854~0.994）和0.902（0.823~0.982）,彩色多普勒超声评估肾功能优于核素肾动态显像。基于ROC曲线,RI诊断肾功能的最佳界值〈0.81,灵敏度0.889,特异度0.933,约登（Youden）指数0.822,准确度0.912;GFR诊断肾功能的最佳界值〈10ml/min,灵敏度0.852,特异度0.864,Youden指数0.719,准确度0.860。RI的灵敏度、特异度、约登指数、准确度均高于GFR。结论在单侧梗阻性中度或重度肾积水患者中,无功能组RI高于有功能组,无功能组GFR低于有功能组。彩色多普勒超声RI评估肾功能的特异度及准确度均高于核素肾动态显像GFR,RI可作为无创性诊断单侧梗阻性中度或重度肾积水肾功能的重要参考指标。

Objective To compare the significance of Color Doppler ultrasound and nuclide nephro- dynam- ic imaging on functional evaluation of the kidney with moderate or severe renal hydronephrosis using ROC curve. Methods A total of 57 patients with moderate or severe unilateral obstructive hydronephrosis were selected in the first hospital of Shijiazhuang from June 2014 to June 2015. The patients were divided into two groups, 27 cases of renal function, 30 cases of renal dysfunction, according to the 24h lead discharge. The resistive index （RI） of renal blood flow and the glomerular filtration rate （GFR） of sick kidneys were detected by Color Doppler ultrasound and nuclide nephro- dynamic imaging respectively to evaluate the function. The results were compared with the findings of 24h drainage volume after percutaneous puncture, and comparing the evaluation value of two methods. Results The mean RI in the non renal function group and exist renal function group were 0.87±0. 06 and 0. 75±0.09, respectively, and the mean GFR were （8. 96±6.34 ） ml/min and （24.8±12.5） ml/min, all the difference were statistically signifcance（ P〈0. 01 ）. The area under ROC curve of RI and GFR in the diagnosis of renal function was significantly larger than the standard reference curve. The area under the curve of RI and GFR evaluation and the 95~ credible period were 0. 924 （0. 854±0. 994） and 0. 902 （0. 823±0. 982）. The best cutoff value of RI diagnosis of renal function based on ROC curve was d0.81, and corresponding sensitivity, specificity, Youden index, accuracy were 0. 889, 0. 933, 0. 822 and 0. 912 respectively. The best cutoff value of GFR was 〈10ml/min, and corresponding sensitivity, specificity, Youden index, accuracy were 0. 852,0. 864,0. 719 and 0. 860 respectively. RI in the diagnosis of renal function significantly was better than GFR. Conclusions In the patients with unilateral obstruction, the RI in the non functional group is higher than that in the functional group, but the GFR was low- er. The specificity and accuracy of color Doppler ultrasound on RI assessment of renal function were higher than that of the radionuclide renal dynamic imaging. The RI, GFR can be used as an important reference index for non- invasive diagnosis of unilateral obstruction of moderate and severe renal function.