彩色多普勒超声对小儿肾积水叶间动脉阻力指数比率测定及肾功能评价价值分析

Analysis of color Doppler ultrasound in the measurement of interlobular arterial resistance index and evaluation of renal function

目的探讨彩色多普勒超声对小儿肾积水叶间动脉阻力指数比率测定及肾功能评价的应用价值。方法选取肾积水患儿58例作为病例组,同期健康儿童70例作为对照组,采用彩色多普勒超声测量2组肾内叶间动脉搏动指数(pulsation index,PI)、阻力指数(resistance index,RI)、收缩期最大血流速度(maxmium systolic blood flow velocity,Vmax)及舒张期最小血流速度(minimum diastolic blood flow velocity,Vmin)。计算动脉阻力指数比率(resistive index ratio,RIR),RIR=患侧肾脏RI/对侧肾脏RI,采用肾核素动态显像法测定病例组患儿肾小球滤过率(glomerular filtration rate,GFR),分析病例组肾脏超声指标与GFR的相关性。结果单侧肾积水患儿健侧肾脏PI和RI值明显低于对照组,肾积水肾脏PI和RI值明显高于对照组和单侧肾积水患儿健侧肾脏,差异有统计学意义(P<0.05)。病例组与对照组的RIR比较,差异有统计学意义(P<0.05);且RIR随着肾积水程度加重呈升高趋势,但Ⅳ度肾积水患儿的RIR呈现降低趋势,差异有统计学意义(P<0.05)。48例单侧肾积水患者患侧肾GFR低于健侧,差异有统计学意义(P<0.01)。肾积水对应一侧肾脏PI与GFR无相关性(r=0.071,P=0.574);RI与GFR呈低度相关性(r=0.506,P=0.041);RIR与GFR呈中度相关性(r=0.731,P=0.026)。结论RIR与肾积水程度有一定相关,且其受年龄因素的影响较小,通过彩色多普勒超声测量RIR,可间接评估小儿肾积水时肾功能情况,可作为初步评估小儿肾积水时肾功能的首选检查手段。

Objective To investigate the value of color Doppler ultrasound in the determination of interlobular artery resistance index and evaluation of renal function in children with hydronephrosis.Methods Fifty-eight children with hydronephrosis were selected as case group,in the same period,70 healthy children as control group,Color Doppler ultrasonography was used to measure the pulsatility index(PI)of interleaf renal artery in 2 groups PI,resistance index(RI),maximum systolic blood flow velocity(Vmax);and Vmax and minimum diastolic blood flow velocity(Vmin).The arterial resistance index ratio(RIR),RIR=RI/contralateral RI were calculated.Glomerular filtration rate of the affected kidney by dynamic renal radionuclide imaging glomerular filtration rate(GFR)was determinated.The correlation between renal ultrasound index and GFR in case group was analyzed.Results The values of PI and RI in the healthy kidney of the children with unilateral hydronephrosis were significantly lower than those in the control group,while the values of PI and RI in the affected kidney of the children with unilateral hydronephrosis were significantly higher than those in the control group and the healthy kidney of the children with unilateral hydronephrosis,the difference was statistically significant(P<0.05).Comparison of RIR between case group and control group,difference was statistically significant(P<0.05).And with the increase of hydronephrosis,the RIR of children with IV degree hydronephrosis decreased,difference was statistically significant(P<0.05).Forty-eight patients with unilateral hydronephrosis had lower renal GFR than healthy patients,difference was statistically significant(P<0.01).There was no correlation between renal PI and GFR(r=0.071,P=0.574);Low correlation between RI and GFR(r=0.506,P=0.041).RIR had a moderate correlation with GFR(r=0.731,P=0.026).Conclusion RIR is related to the degree of hydronephrosis,and it is less affected by age factors.Color Doppler ultrasound can indirectly evaluate the renal function of children with hydronephrosis RIR,It can be used as the first choice to evaluate renal function in children with hydronephrosis.