声脉冲辐射力成像对过敏性紫癜性肾炎定量诊断的临床价值

Clinic value of acoustic radiation force impulse on quantitatively diagnosing henoch-schonlein purpura nephritis

目的探讨声脉冲辐射力成像在过敏性紫癜性肾炎(HSPN)肾功能分期诊断中的价值。方法选取89例临床确诊为HSPN患者为研究对象,选取40例健康志愿者为对照组。检测HSPN患者肾小球滤过率(GFR),按照肾功能损伤程度,将患者分为1期9例、2期40例、3期29例、4期11例,同时检测HSPN患者和健康志愿者肾皮质剪切波速度(SWV),进行统计学分析。结果 89例HSPN患者肾皮质SWV值为3.15±0.53 m/s,40例健康志愿者肾皮质SWV值为2.04±0.25 m/s,两组比较,F=160.96,P=0.000 1,差异有统计学意义;肾功能损伤1-4期HSPN患者各组肾皮质SWV值比较,差异均有统计学意义(P<0.05)。肾皮质SWV值诊断HSPN的临界点为2.40 m/s,特异性为100%,敏感性为96.6%,曲线下面积为0.989。散点图观察HSPN患者肾皮质SWV值与GFR间存在负相关。HSPN患者肾皮质SWV值与肾功能损伤程度呈线性正相关(r=0.802,P=0.000 1)。结论 HSPN患者肾皮质SWV值随肾功能损害的加重而增高,故声脉冲辐射力成像可用于HSPN患者肾功能损伤程度的定量诊断,对于HSPN的早期诊断具有较高诊断价值。

Objective To explore the value of acoustic radiation force impulse in diagnosis of renal function stages for henoch-schonlein purpura nephritis （HSPN）. Methods 89 patients with HSPN were treated as study objects, 40 healthy volunteers for control. Glomerular filtration rate was measured for HSPN groups. According to the renal function stage, they were divided into stage 1 （9 cases）, stage 2 （40 cases）, stage 3 （29 cases）, stage 4 （11 cases）. In HSPN group and control group,shear wave velocity （SWAT） was measured to analyze the renal cortical elasticity, then statistical analysis was conducted. Results The SWV of HSPN group was 3.15＋0.53 m/s, the SWV of control group was 2.04＋0.25 m/s, there was significant difference in SWV between HSPN group and control group （F=160.96, P=0.000 1）. there was significant difference in SWV among stage 1, stage 2, stage 3, stage 4 （P 〈 0.05）. The threshold of renal cortical SWV of HSPN group was 2.40 m/s, specificity, sensitivity and Area under curve were 100%, 96.6% and 0.989 respectively. Negative correlation between renal cortical SWV and GFR was observed by scatter plot. The SWV was linear positively correlated with renal function in HSPN group （r=0.802, P=0.000 1）. Conclusion the value of SWV was increased with the progress of renal function damage. Therefore ARFI is valuable in quantitative assessment of renal function for HSPN. It has advantage of ARFI for early stage of HSPN patients.