实时剪切波弹性成像在儿童过敏性紫癜肾炎诊断中的应用价值

Application Value of Real-Time Shear Wave Elastography in Diagnosis of Children with Henoch-Sch nlein Purpura Nephritis

目的探讨实时剪切波弹性成像(SWE)在儿童过敏性紫癜肾炎(HSPN)诊断中的应用价值及其与病理分级的相关性。方法选取2017年1月至2019年6月昆明市儿童医院肾内科收治的150例经肾穿刺活组织检查病理证实的HSPN患儿作为观察组,病理分级Ⅰ级0例,Ⅱ级34例,Ⅲ级66例,Ⅳ级23例,Ⅴ级16例,Ⅵ级11例。选择同期50名性别、年龄相匹配的正常儿童作为对照组。分别采用SWE技术检测各组肾实质硬度,取弹性模量平均值(Emean值),评价对照组与观察组Emean的差异;与病理穿刺活组织检查结果对照,分析Emean与病理分级的相关性。结果观察组各病理分级与对照组的Emean值比较差异有统计学意义(P<0.01),观察组病理Ⅲ级、Ⅳ级、Ⅴ级、Ⅵ级Emean值高于对照组[(14.3±3.9)kPa、(20.0±6.6)kPa、(25.9±8.3)kPa、(34.3±6.4)kPa比(6.5±1.1)kPa](P<0.05),观察组病理Ⅱ级与对照组Emean值比较差异无统计学意义(P>0.05)。以病理穿刺结果为金标准,构建受试者工作特征曲线,HSPN患儿病理Ⅲ级、Ⅳ级、Ⅴ级、Ⅵ级的受试者工作特征曲线下面积分别为0.966、0.886、0.924及0.979,阈值分别为8.80、17.55、18.80、25.15 kPa。HSPN患儿病理分级与肾实质Emean值呈正相关(r s=0.779,P<0.001)。结论SWE定量分析有助于评估HSPN肾实质损害程度,对疾病诊断、疗效观察、评估预后有一定参考价值。

Objective To explore the value of real-time shear wave elastography(SWE)in the diagnosis of Henoch-Sch nlein purpura nephritis(HSPN)of children and its correlation with the pathological grading.Methods A total of 150 cases of HSPN confirmed by renal biopsy pathology admitted to the Department of Nephrology of Kunming Children′s Hospital from Jan.2017 to Jun.2019 were included as an observation group,pathological grade:0 case of gradeⅠ,34 cases of gradeⅡ,66 cases of gradeⅢ,23 cases of gradeⅣ,16 cases of gradeⅤ,11 cases of gradeⅥ.50 normal children of matched sex,age during the same period were included as a control group.SWE technology was used to test the renal parenchymal hardness of each group,and the mean elastic modulus(Emean)was obtained to compare the difference of the control group and the observation group;the correlation between Emean and pathological grade was analyzed by comparing with the pathological result of puncture biopsy.Results The pathological grades in the observation group were significantly different from those in the control group(P<0.01),the Emean values of pathological gradesⅢ,Ⅳ,ⅤandⅥsubgroups in the observation group were higher than those in the control group[(14.3±3.9)kPa,(20.0±6.6)kPa,(25.9±8.3)kPa,(34.3±6.4)kPa vs(6.5±1.1)kPa](P<0.05),there was no significant difference between the pathological levelⅡsubgroup of the observation group and the control group(P>0.05).Based on the results of pathological puncture,the receiver operating characteristic curve(ROC curve)was constructed.The area under the ROC curve of pathological gradesⅢ,Ⅳ,ⅤandⅥin HSPN children was 0.966,0.886,0.924,and 0.979 respectively,and the threshold was 8.80,17.55,18.80,and 25.15 kPa,respectively.The pathological grade of children with HSPN was positively correlated with the renal parenchymal Emean value(r s=0.779,P<0.001).Conclusion SWE quantitative analysis is helpful to assess the renal parenchyma damage in HSPN,and has some reference value for the disease diagnosis,curative effect observation and prognosis assessment.