痛风患者肾脏结石超声分型及临床价值的研究

The clinical value of ultrasound type of kidney stones in patients with gout

目的:探讨痛风患者肾脏结石超声分型与血尿酸水平、病程、肾动脉血流的关系。方法:选取2017年2月至2018年8月广西医科大学第一附属医院临床诊断为痛风的患者80例,依据二维超声检测结果将肾结石分为无结石型(Ⅰ型)、肾盂肾盏结石型(Ⅱ型)和锥体回声增强型(Ⅲ型);以双肾结石超声分型将患者分为A组(双肾均为Ⅰ型)、B组(双肾均为Ⅱ型,或一侧肾为Ⅱ型而另一侧肾为Ⅰ型)和C组(一侧或双侧肾为Ⅲ型)。比较3组血尿酸水平;比较3种超声分型肾脏肾段动脉、叶间动脉、小叶间动脉收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及阻力指数(RI)的差异。结果:C组血尿酸水平高于B组和A组,且B组高于A组(均P<0.05)。C组病程长于B组和A组,且B组长于A组(均P<0.05)。Ⅲ型肾脏肾段动脉、叶间动脉、小叶间动脉PSV、EDV血流速均低于Ⅰ、Ⅱ型肾脏,而RI高于Ⅰ、Ⅱ型肾脏(均P<0.05)。结论:超声诊断痛风患者肾结石并对其进行分型可判断肾脏结石严重程度;Ⅲ型结石肾脏肾动脉血流高阻力、血流速降低,预示肾功能改变,可为临床选择治疗方案提供参考依据。

Objective:To investigate the relationship between ultrasound classification of kidney stones and renal blood flow parameters,course of disease and blood uric acid level in patients with gout.Methods:Eighty patients with gout in our hospital from February 2017 to August 2018 were selected.According to the occurrence of kidney stones by two-dimensional ultrasonic detecting,the bilateral kidneys are divided into ultrasound typeⅠ,typeⅡand typeⅢ.And patients were divided into group A,group B and group C according to the type of kidney stone.The blood uric acid level was compared among three groups.The PSV,EDV and RI of renal segmental arteries,interlobular arteries,interlobular arteries were compared among three types.Results:The uric acid level in group C was higher than that in group B and group A,and that of group B was higher compared with group A(P<0.05).The disease duration of group C was longer than that of group B and group A,and it was longer in group B(P<0.05).The PSV and EDV of renal segmental artery,interlobar artery and interlobular artery in typeⅢwere lower than those in typeⅠandⅡ(P<0.05),and the RI was higher(P<0.05).Conclusion:The severity of kidney stone can be judged by ultrasonic diagnosis and classification of kidney stone in patients with gout;high resistance of renal artery blood flow and low blood flow velocity in typeⅢstone predict the change of renal function,which can provide reference for clinical choice of treatment.