实时剪切波弹性成像在肾小球肾炎早期诊断中的应用价值

Application Value of Real-time Shear Wave Elastography Elasticity in Early Diagnosis of Glomerulonephritis

目的初步探讨实时剪切波弹性成像(SWE)对于成人早期慢性肾小球肾炎(CGN)的肾脏纤维化的诊断价值。方法选取我院2018年1~12月经病理确诊的早期CGN患者40例,根据我国改良简化的MDRD方程估测的肾小球滤过率(GFR)分为CGN1期组20例[GFR≥90 ml/(min·1.73 m^2)],CGN2期组20例[GFR 60~89 ml/(min·1.73 m^2)],另选取同期健康体检人群30名设为健康对照组,比较两组肾脏杨氏模量、肾脏长径、宽径及肾下极实质厚度。采用Pearson方法对于肾脏杨氏模量与生化指标进行相关性分析,以病理结果为标准,建立ROC曲线确定SWE评价早期CGN的诊断临界点。结果CGN组与健康对照组肾脏长径、宽径及肾下极实质厚度比较,差异均无统计学意义(P<0.05);CGN2期组SWE测值高于CGN1期组及健康对照组(P<0.001);SWE测值与e GFR呈负相关(r=-0.591、-0.588、-0.579,P<0.001);以2.49 m/s为诊断CGN2期CGN的最佳诊断界值,其对应的敏感度为77.30%,特异度为68.00%,ROC曲线下面积为0.781。结论剪切波弹性成像技术可定量评价肾脏组织弹性,反映肾功能的改变,可用于CGN的早期诊断。

Objective To explore the value of real-time shear wave elastography(SWE)in the diagnosis of renal fibrosis in early adult chronic glomerulonephritis(CGN).Methods 40 cases of early CGN patients diagnosed by pathology from January to December 2018 in our hospital were selected,and the glomerular filtration rate(GFR)estimated by China’s modified and simplified MDRD equation was divided into 20 cases of CGN1 group[GFR≥90 ml/(min·1.73 m^2)],20 patients in the CGN2 group[GFR 60~89 ml/(min·1.73 m^2)],and another 30 healthy people in the same period were selected as the healthy control group to compare the two groups of kidney modulus,kidney long diameter,wide diameter,and infrarenal thickness.Pearson’s method was used to analyze the correlation between kidney Yang’s modulus and biochemical indicators.Based on the pathological results,a ROC curve was established to determine the critical point of early diagnosis of CGN by SWE.Results There was no statistically significant difference in the length and width of the kidney and the thickness of the lower subrenal parenchyma between the CGN group and the healthy control group(P<0.05);the SWE value of the CGN2 group was higher than that of the CGN1 group and the healthy control group(P<0.001);SWE measured value is negatively correlated with e GFR(r=-0.591,-0.588,-0.579,P<0.001);2.49 m/s is the best diagnostic cutoff value for the diagnosis of CGN stage 2 CGN,and its corresponding sensitivity is 77.30%,the specificity is 68.00%,and the area under the ROC curve is 0.781.Conclusion Shear wave elastography can quantitatively evaluate the elasticity of kidney tissue,reflect the change of renal function,and can be used for the early diagnosis of CGN.