动态增强MRI肾图评估慢性乙型肝炎早期肾损害的价值

Evaluation of early kidney injury induced by chronic B virus hepatitis using dynamic contrast enhanced MRI renogram

目的:探讨动态增强(DCE)MRI测量慢性乙型肝炎相关性早期肾损害患者肾小球滤过率(GFR)的准确性。方法:21例慢性持续性HBV肝炎纳入本前瞻性研究,所有患者均进行DCE-MRI检查、核素肾图检查和生化检查,获得GFRMRI、GFRSPECT和临床估算肾小球滤过率(eGFR)。以GFRSPECT为金标准,采用配对t检验、Pearson相关性分析和Bland-Altman分析评价GFRMRI、eGFR和GFRSPECT相关性和一致性。结果:eGFR与GFRSPECT差异具有统计学意义(t=4.615,P=0.00),GFRMRI与GFRSPECT差异无统计学意义(t=1.872,P=0.08)。GFRMRI与GFRSPECT之间(r=0.83,P<0.001)较eGFR与GFRSPECT(r=0.57,P=0.01)具有更好的相关性。在Bland-Altman分析中,GFRMR与GFRSPECT结果的差值(5.4±13.3)mL/min较eGFR与GFRSPECT的差值(22.0±21.9)mL/min小,提示GFRMR与GFRSPECT一致性更高。结论:作为反映慢性乙型肝炎早期肾损害的重要指标,DCE-MRI获得的GFR结果较eGFR具有更好的准确性。

Objective： To evaluate the accuracy of dynamic contrast enhanced （DCE） MRI to measure the glomerular filtration rate （GFR） in early kidney injury induced by chronic B virus hepatitis （HBV）. Methods：Twenty-one patients with chronic HBV were enrolled in this prospective study,all patients underwent DCE MRI, dynamic scintigraphic renography and biochemical assay to obtain the GFR measurements,including GFRMR,GFRSPECT and eGFR. GFRSPECT was regarded as the golden standard, the correlation and consistence of GFRMR, eGFR with GFRSPECT were analyzed by t test, Pearson correlation and Bland-Altman analysis. Results：The results between eGFR and GFRSPECT had significant statistic difference （t= 4.615, P = 0.00）, while results between GFRMRI and GFRSPECT had no significant difference （t = 1.872, P=0.08）. The correlation between GFRMR and GFRSPECT （r=0. 83,P=0.00） is better than that of eGFR and GFR- SPECT （r= 0. 57, P = 0. 01）. As of Bland-Altman analysis, the discrepancy from GFRMR and GFRSPECT （5. 4 ± 13.3） mL/min is smaller than that from eGFR and GFRSPECT （22.0 ± 21.9） mL/min. Conclusion：As an important indicator for the early kidney injury induced by chronic HBV,the GFR result obtained from DCE MRI is more accurate than that of eGFR.