实时剪切波弹性成像评估原发性肾病综合征肾脏硬度的临床研究

Real-time shear wave elastography in measuring renal stiffness of primary nephrotic syndrome:a clinical study

目的应用实时剪切波弹性成像技术(SWE)测量分析不同病理类型原发性肾病综合征患者肾脏硬度的差异,探讨其临床应用价值。方法选取200例肾脏正常人为正常对照组,51例经临床确诊的原发性肾病综合征患者为病例组,并根据病理结果进一步分为4个亚组:微小病变型肾病组(MCN组)、系膜增生性肾小球肾炎组(MSPGN组)、局灶性节段性肾小球硬化组(FSGS组)、膜性肾病组(MN组)。应用SWE测量各组双侧肾脏实质的弹性模量平均值(Mean)、最大值(Max)、最小值(Min)和弥散度(SD),并进行比较。结果病例组肾脏Mean、Max、Min均明显高于正常对照组,差异均有统计学意义(均P<0.05)。MSPGN组、FSGS组、MN组的肾脏Mean、Max、Min均高于正常对照组和MCN组,差异均有统计学意义(均P<0.05);余各组两两比较,差异均无统计学意义。结论应用SWE检测双肾的弹性模量值,可初步评估不同病理类型原发性肾病综合征患者肾硬度的变化,为早期肾弥漫性病变提供一定的诊断和分型依据。

Objective To investigate the differences of renal stiffness in patients with different pathological types ofprimary nephrotic syndrome by real-time shear wave elastography(SWE),and to explore its clinical application value.MethodsFifty-one patients with primary nephrotic syndrome as case group and 200 normal subjects as normal control groupwere involved in this research.According to the pathologic results,the case group was further divided into four subgroups:micropathological nephropathygroup(MCN group),mesangial proliferative glomerulonephritis group(MSPGN group),focalsegmental glomerulosclerosis group(FSGS group),and membranous nephropathy group(MN group).SWE was used to measurethe average(Mean),maximum(Max),minimum(Min),and diffusion(SD)elastic modulus of the bilateral renal parenchyma ineach group,and the results were compared.ResultsThe Mean,Max,and Min of the kidneys in the case group were significantlyhigher than those in the normal control group,and the differences were statistically significant(all P<0.05).The Mean,Max,andMin of the MSPGN group,the FSGS group,and the MN group were higher than those of the normal control group and the MCN group,and the differences were statistically significan(tall P<0.05).The other groups were compared in pairs and the differenceswere not statistically significance.Conclusion SWE can primarily evaluate the changes of renal stiffness in patients withprimary nephrotic syndrome with different pathologic types preliminarily by measuring the elastic modulus of bilateral kidneys,which has certain clinical value in providing a certain basis for diagnosis and typing of early diffuse renal disease.