早期慢性肾脏病肾皮质声触诊组织定量剪切波速度参考值的初步研究

Preliminary study of renal cortex palpate organization quantitative SWV reference value in early chronic kidney disease(CKD)

目的探讨运用声触诊组织定量技术(virtual touch tissue quantification,VTQ)测量剪切波速度(shear wave velocity,SWV)的变化与早期慢性肾脏病(chronic kidney disease,CKD)分期的相关性,探索早期CKD肾皮质声触诊组织定量SWV的参考值范围。方法选择2015年3月至2016年8月广东省中医院珠海医院诊断为CKD的患者180例,运用VTQ技术对CKD患者进行SWV值测量;选择无CKD的正常志愿者100例做为对照组,进行SWV值测量。按照肾脏疾病膳食改良实验(modification of diet in renal disease,MDRD)方法依据肌酐清除率将180例CKD患者分为5组,其中CKD 1期组61例,CKD 2期组53例,CKD 3期组56例,CKD4期组6例,CKD 5期组4例。结果 CKD组与对照组的平均SWV值分别是(2.20±0.68)m/s和(2.38±0.84)m/s,2组间差异无统计学意义(P>0.05),CKD的分期与SWV值的变化呈一定负相关趋势,但CKD各期的SWV值无明显统计学差异(P>0.05);CKD各组间分别与对照组比较,差异也无统计学意义(P>0.05),合并后的CKD 1~2期及CKD 4~5期与对照组比较,差异也无统计学意义(P>0.05),CKD各分期组的肾小球滤过率值比较,差异有统计学意义(P<0.05)。结论 VTQ技术可以测量肾脏的SWV值,SWV值与CKD损害程度差异有一定的负相关关系(r=-0.422,P=0.032),可以在一定程度上评价中晚期肾脏损害。

Objective To investigate the relationship between the shear wave velocity （SWV） measured by virtual touch tissue quantification（VTQ） and the stage of early chronic kidney disease （CKD）, and to provide SWV reference range of early CKD. Methods One hundred and eighty CKD patients and 100 control subjects without CKI） were enrolled in this prospective study from March 2015 to August 2016. SWV was measured by using VTQ inspection of color Doppler ultrasound. CKD patients were divided into 5 groups based on creatinine clearance calculated with MDRD formula. There are 61, 53, 56, 6 and 4 cases in CKD stage 1 to 5, respectively. Results The average SWV val- ue of the study group and control group were （2. 20± 0. 68） m/s and （2. 38± 0. 84） m/s, respectively. There were no significant difference between these two groups （P〉0. 05）. The stage of CKD is negatively related to the SWV vale in trends, but has no significant difference（P〉0. 05）, and each group respectively when compared with the control group had no statistical significance（P〉0. 05）. The combined CKD 1-2 stage and CKD 4-5 stage respectively compared with the control group had no statistical difference（P〉0. 05）. But the combined CKD 3-5 stage respectively compared with the con- trol group. CKD1 stage and CKD 1-2 stage there were significant difference（P〈0. 05）. GFR value comparison between different CKD stage groups have obvious difference（P〈0. 05）. Conclusions The SWV can be detected with VTQ and can be used to evaluate the degree of injury in mid-late stageCKD. The SWV value correlates with the degree of injury in CKD patients negatively（r = - 0. 422,P = 0. 032）.