CEUS诊断肢体肌肉挤压伤后急性肾损伤

CEUS diagnosis of acute kidney injury after limb muscle crush injury

目的探讨CEUS在肢体肌肉挤压伤后急性肾损伤早期诊断及监测中的价值。方法选取新西兰大白兔为实验动物,分为实验组和对照组。实验组采用袖带球囊加压法制备肢体肌肉挤压伤后急性肾损伤模型,对照组不加压。于模型制备成功后第0.5、2.0、6.0、24.0h及3、7、14天对左肾行CEUS,计算峰值强度(PI)、曲线下面积(AUC)、升支斜率(AS)及降支斜率(DS);并检测血清肌酸肌酶(CK)、乳酸脱氢酶(LDH)、血尿素氮(BUN)及血肌酐(Cr);根据不同时间点将实验组分为不同亚组。检测完毕后处死实验动物,取左肾组织固定后制备病理切片观察。结果实验组各亚组和对照组血清CK、LDH、BUN、Cr差异有统计学意义(P均<0.05),且实验组中2.0、6.0、24.0h及3天亚组明显高于对照组(P均<0.05)。实验组各亚组和对照组CEUS定量参数PI、AUC、AS及DS差异均有统计学意义(P均<0.05),与对照组比较,实验组各亚组AS及DS减小(P均<0.05),但实验组各亚组间差异无统计学意义(P>0.05)。结论 CEUS可较敏感地反映兔挤压伤后急性肾损伤的改变。

Objective To explore the value of quantitative contrast enhanced ultrasonography （CEUS） in early diagnosis and monitoring of acute kidney injury （AKI） after limb muscle crush injury. Methods Totally 64 New Zealand white rabbits were selected and divided into experimental group （n= 56） and control group （n= 8）. Models of AKI were prepared by applying cuff balloon pressure in experimental group, while rabbits in the control group was not given pressure. CEUS of the left kidney was performed at 0.5 h, 2.0 h, 6.0 h, 24.0 h, 3 days, 7 days, 14 days after model establishment. Rabbits in experimental group were divided into different subgroups according to different time points. Peak intensity （PI）, area under the curve （AUC）, ascending slope （AS） and descending slope （DS） were calculated. The serum levels of creatine kinase （CK）, lactic dehydrogenase （LDH）, blood urea nitrogen （BUN）, creatinine （Cr） were measured. Then the rabbits were sacrificed, and the left renal tissues were fixed for histological observation. Results The levels of CK, LDH, BUN and Cr had statistical differences among all subgroups in experimental group and control group （all P〈0.05）, of 2.0, 6.0, 24.0 h and 3 days subgroups in experimental group were significantly higher than those of control group （all P〈 0.05）. PI, AUC, AS, DS among all subgroups in experimental group and control group had statistical differences （all P〈 0.05）. Compared with control group, AS and DS decreased in all subgroups in experimental group （all P〈0.05）, but there was no statistical differences among all subgroups in experimental group （P〉0. 05）. Conclusion CEUS can be used to effectively reflect the changes of AKI after crush injury.