超声造影定量分析技术诊断早期慢性肾病的临床价值

Quantitative analysis and assessment of contrast-enhanced ultrasound in the diagnosis of early chronic kidney disease

目的探讨超声造影定量分析技术在评估慢性肾病(CKD)早期肾皮质血流灌注改变的可行性及其临床应用价值。方法选取早期慢性肾病30例;正常对照组30例;二维灰阶超声及彩色多普勒超声测量右肾大小及皮质的厚度,上极段动脉的收缩期最大峰值速度(Vmax)和阻力指数(RI)。所有受检者均进行右肾实时超声造影检查,用SonoliverR CAP软件对肾皮质进行定量分析,获得时间-强度曲线(TIC)并获得相关灌注参数:峰值强度(Imax)、上升时间(RT),达峰时间(TTP),平均渡越时间(m TT)、曲线下面积(AUC)。对上述参数进行统计学分析,对有统计学差异的参数与24h尿蛋白量进行相关性分析。结果常规超声下CKD早期患者的右肾大小、皮质厚度、收缩期峰值流速、阻力指数与正常对照组之间差异无统计学意义(P>0.05值),超声造影下CKD早期病例组AUC升高、Imax降低、m TT升高P>0.05;肾病组的RT、TTP与对照组之间无统计学意义(P<0.05),其中AUC,m TT与24h尿蛋白量呈正相关,(r=0.710,0.637,P<0.05),Imax与24h尿蛋白量呈负相关(r=-0.613,P<0.05)。结论超声造影定量分析技术可较敏感客观的反映早期慢性肾病肾皮质微循环的血流灌注特点,该技术可作为临床评价早期慢性肾病患者的肾脏微循环变化的手段之一。

Objective The objective of this study is to explore the feasibility and clinical value of quantitative analysis of contrast-enhanced ultrasound （CEUS） in evaluating the blood flow peffusion of renal cortex in early chronic kidney disease. Methods 30 patients with early chronic kidney disease were recruited; 30 eases were normal; First, we observed the morphological chan- ges, cortex and medulla echoes and the size of right kidney and thickness of the cortex in two-dimensional ultrasound （2D-US）. In color Doppler ultrasound （CDFI）, measurement of right kidney pole segmental artery the maximum peak velocity （Vmax） and the resistance index （hi） were conducted. Quantitative analysis through SonoLiverR software was performed to obtain the time-intensity curve （TIC） ; Indexes such as the maximum intensity （Imax） , the rise time （RT）, time to peak （TTP） , mean transit time （mTT）, the area under the curve（AUC） were statistcally analysed, Through statistical analysis of the above data, correla- tion analysis was conducted to assess the correlation between the parameters of statistical significance and 24 h urinary protein. Results In two dimensional ultrasound and color Doppler flow image examination, no statistically significant dift）renee was ob- served in the shape and size of right kidney, segmental artery systolic peak velocity and resistance index between the normal con- trol group and case group for early CKD （ P 〉 0.05 ） detection of the renal cortex blood peffusion parameters obtained by ultrasound contrast quantitative analysis technology had been changing in the early stages of CKD, and compared to normal group, the peak of the peak intensity （Imax） will be weakened, area under the curve （AUC） increases, mean transit time （mTT） extemted and rise time （RT）, time to peak （TTP） and no statistical significance P 〈 0.05. AUC, mTT and 24 h urinary protein was posi- tively eorelated （ r = 0.710, 0. 637, P 〈 0.05）. Imax was negatively correlated with the 24 h ruinary protein （ r = -0. 613, P 〈 0.05 ）. Conclusion Contrast enhanced ultrasound （CEUS） in quantitative analysis technology for the micro vascular peffusion of renal cortex can give a comprehensive objective evaluation of the early stages of CKD. The technology can be as a elinical evaluation in patients with early chronic kidney disease of renal mieroeirculation preferred means.