声辐射力脉冲成像技术在早期慢性肾实质损害中的临床应用

Clinical application of acoustic radiation force impulse in diagnosis of early chronic renal parenchymal damage

目的探讨声辐射力脉冲成像技术(ARFI)在早期慢性肾实质损害中的临床应用价值。方法 A组200例超声和实验室检查均正常的体检人员测定ARFI值;B组102例超声表现正常但ARFI值高于正常值,每一患者两肾平均ARFI值作为最终ARFI值,并且均测定血肌酐值,再比较ARFI值和血肌酐值的关系。并按ARFI值由低到高平均分为b1、b2、b3组,每组34例。C组239例(凝似肾功能异常的肾)实质回声稍强患者再分为2组,c1组靠二维声表现及操作者的经验去判断肾功是否正常;c2组利用ARFI值去判断肾功是否正常,2组间进行比较。结果 (1)A组肾皮质ARFI值2.45～3.46 m/s,平均(2.82±0.33)m/s;(2)B组超声表现正常但ARFI高于正常值的患者,肌酐高于正常值83例,正常范围19例,临床符合率高达81.4%;(3)b1、b2、b3组患者(每组34例,共102例)随ARFI值的增高,肌酐值也相应增高,ARFI值(3.21±0.12)～(3.59±0.45)m/s,肌酐值从(86±25)mmol/L增高到(132±28)mmol/L,且随ARFI值的增高,肌酐高于正常的临床符合率越高,从67.6%上升到94.1%。不同组别比较,ARFI值与肌酐值差异均有统计学意义(P<0.05);(4)c1组中肌酐值检测肾功能比较差异有统计学意义(χ~2=12.237,P<0.05),其敏感度71.4%,特异度60.9%,准确度67.5%。C2组肌酐值检测肾功能比较差异无统计学意义(χ~2=0.569,P>0.05),其敏感度90.7%,特异度64.5%,准确度84.3%,敏感度及准确度均较高,特异度比较低。结论借助声辐射力脉冲成像技术,能够更多更早的发现早期慢性肾实质损害患者,有很高的临床应用价值。

Objective To investigate the the clinical application value of acoustic radiation force impulse(ARFI) in diagnosis of early chronic renal parenchymal damage. Methods A total of 200 patients (group A) with normal ultrasound and laboratory examination results were enrolled in the study, who were examined by ARFI. The other 102 patients (group B) with normal ultrasonographic appearance whose ARFI value was higher than normal value were underwent serum creatinine detection. The relationship between ARFI value and serum creatinine value was analyzed.Moreover 239 patients(group C) with slightly stronger parenchymal echoes were divided into two groups:the renal function was evaluated by two-dimensional echoes and the operator’s experience,however, which in the other group was evaluated by ARFI value. Results The ARFI value of renal cortex in healthy subjects was 2.45~3.46m/s, average (2.82±0.33)m/s.In group B 83 patients had higher creatinine levels, and 19 patients had normal reatinine levels,with clinical coincidence rate being 81.3%.With the increase of ARFI value, the creatinine levels in the c1 group、c2 group、c3 group were increased correspondingly,moreover,the ARFI value was increased from (3.21±0.12)m/s to (3.59± 0.45 )m/s, and the creatinine value was increased from (86±25)mmol/L to (132±28)mmol/L. The higher of ARFI value, the higher clinical coincidence rate of creatinine increase (67.6% to 94.1%). There were significant differences in the diffenrences of ARFI and creatinine among different groups ( P <0.05).There was significant difference in detection of renal function between two-dimensional ultrasound and creatinine detection (χ^2=12.237, P <0.05). The sensitivity, specificity and accuracy were 71.4%, 60.9% and 67.5%,respectively.However there was no significant difference in detection of renal function between ARFI value and creatinine value test(χ^ 2=0.569, P >0.05). The sensitivity, specificity and accuracy were 90.7%, 64.5% and 84.3%, respectively. The sensitivity and accuracy were higher,but the specificity was lower. Conclusion The acoustic radiation force pulse imaging technique can find the patients with early chronic renal parenchymal damage more early, which has higher clinical application value.