声触诊组织定量技术诊断不同时期移植肾急性排斥反应的临床价值

Clinical value of virtual touch tissue quantification technique in diagnosing acute rejection of transplant kidney at different stages

目的探讨声触诊组织定量(VTQ)技术在诊断不同时期移植肾急性排斥反应中的临床价值。方法回顾性分析170例肾移植受者的临床资料。根据受者行VTQ检查的时间以及肾移植术后急性排斥反应的发生情况,将肾移植术后4周内和术后4周后的受者分为肾功能正常组(41例和51例)、急性排斥反应组(22例和56例)。比较肾移植术后不同时期肾功能正常组和急性排斥反应组的临床超声参数情况;分析超声参数在肾移植术后不同时期急性排斥反应中的诊断价值。结果肾移植术后4周内,急性排斥反应组的阻力指数(RI)和剪切波速度(SWV)均明显高于肾功能正常组(均为P<0.001);术后4周后,急性排斥反应组SWV明显高于肾功能正常组(P<0.001)。术后4周内,RI、SWV诊断急性排斥反应的曲线下面积(AUC)分别为0.729、0.803;术后4周后,RI、SWV诊断急性排斥反应的AUC分别为0.478、0.794,SWV的诊断价值高于RI(P<0.05)。术后4周内SWV诊断急性排斥反应的截断值高于术后4周后。结论VTQ技术能有效辅助诊断不同时期移植肾急性排斥反应。

Objective To explore the clinical value of virtual touch tissue quantification(VTQ)technique in the diagnosis of acute rejection of transplant kidney at different stages.Methods Clinical data of 170 renal transplant recipients were retrospectively analyzed.According to the time of VTQ examination and the occurrence of acute rejection after renal transplantation,the recipients within 4 weeks and after 4 weeks post-renal transplantation were assigned into the normal renal function group(n=41,51)and acute rejection group(n=22,56).Clinical ultrasound parameters at different stages after renal transplantation were compared between two groups.The diagnostic value of ultrasound parameters in acute rejection at different stages after renal transplantation was evaluated.Results Within 4 weeks post-renal transplantation,the resistance index(RI)and shear wave velocity(SWV)in the acute rejection group were significantly higher than those in the normal renal function group(both P<0.001).After 4 weeks post-renal transplantation,the SWV in the acute rejection group was significantly higher than that in the normal renal function group (P<0.001). Thearea under curve (AUC) of RI and SWV in the diagnosis of acute rejection were 0.729 and 0.803 respectively within 4weeks post-renal transplantation, which were 0.478 and 0.794 respectively after 4 weeks post-renal transplantation. Thediagnostic value of SWV was higher than RI (P<0.05). The cutoff value of SWV in the diagnosis of acute rejection within4 weeks post-renal transplantation was considerably higher than that after 4 weeks post-renal transplantation. ConclusionsVTQ technique can effectively assist in diagnosing acute rejection of transplant kidney at different stages.